Provider Demographics
NPI:1457385148
Name:SHELTON, GEORGE ANDY (IDC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ANDY
Last Name:SHELTON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6265
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98315-6265
Mailing Address - Country:US
Mailing Address - Phone:360-476-4373
Mailing Address - Fax:360-476-6781
Practice Address - Street 1:USS HENRY M JACKSON
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:MILITARY
Practice Address - Zip Code:96698-2107
Practice Address - Country:US
Practice Address - Phone:360-476-6091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman