Provider Demographics
NPI:1376366450
Name:SHELTON, KELAND O'NEAL (CERTIFIED PEER RECOV)
Entity type:Individual
Prefix:
First Name:KELAND
Middle Name:O'NEAL
Last Name:SHELTON
Suffix:
Gender:M
Credentials:CERTIFIED PEER RECOV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 F STREET
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112
Mailing Address - Country:US
Mailing Address - Phone:276-732-0606
Mailing Address - Fax:
Practice Address - Street 1:1011 F ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4049
Practice Address - Country:US
Practice Address - Phone:276-732-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)