Provider Demographics
NPI:1295908762
Name:SHELTON, ANGELA MARIE (AUD, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:BURNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-A
Mailing Address - Street 1:110 JOHNSON LN
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1321
Mailing Address - Country:US
Mailing Address - Phone:606-546-5109
Mailing Address - Fax:606-546-4199
Practice Address - Street 1:110 JOHNSON LN
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1321
Practice Address - Country:US
Practice Address - Phone:606-546-5109
Practice Address - Fax:606-546-4199
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0242231H00000X
TN1142237600000X
KY621237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist