Provider Demographics
NPI:1275610628
Name:SHELTON, ASHLEY C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:C
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 MARLA CT
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8797
Mailing Address - Country:US
Mailing Address - Phone:330-722-4000
Mailing Address - Fax:
Practice Address - Street 1:3035 MARLA CT
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8797
Practice Address - Country:US
Practice Address - Phone:330-722-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5079103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist