Provider Demographics
NPI:1184335341
Name:FELTON, STEPHON
Entity type:Individual
Prefix:
First Name:STEPHON
Middle Name:
Last Name:FELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 HAZELNUT DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2183
Mailing Address - Country:US
Mailing Address - Phone:937-716-9681
Mailing Address - Fax:
Practice Address - Street 1:2378 HAZELNUT DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2183
Practice Address - Country:US
Practice Address - Phone:937-716-9681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide