Provider Demographics
NPI:1013316793
Name:SHELTON, DARLENE (PHD)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TALIAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3225
Mailing Address - Country:US
Mailing Address - Phone:203-453-1489
Mailing Address - Fax:203-453-2017
Practice Address - Street 1:3 TALIAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-3225
Practice Address - Country:US
Practice Address - Phone:203-453-1489
Practice Address - Fax:203-453-2017
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical