Provider Demographics
NPI:1205970878
Name:SHELTON, MATTHEW THOMAS (ATC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:SHELTON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 ELIAS CT
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-9621
Mailing Address - Country:US
Mailing Address - Phone:610-398-1849
Mailing Address - Fax:
Practice Address - Street 1:1100 W MAIN ST
Practice Address - Street 2:STROUDSBURG HIGH SCHOOL
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1332
Practice Address - Country:US
Practice Address - Phone:570-421-1991
Practice Address - Fax:570-424-0789
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002504A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer