Provider Demographics
NPI:1649273269
Name:SHELTON, VICKI K (MD)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:K
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13250 HAZEL DELL PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033
Mailing Address - Country:US
Mailing Address - Phone:317-848-4000
Mailing Address - Fax:317-848-4455
Practice Address - Street 1:13250 HAZEL DELL PKWY
Practice Address - Street 2:STE 105
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8527
Practice Address - Country:US
Practice Address - Phone:317-848-4000
Practice Address - Fax:317-848-4455
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027864174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
D14916Medicare UPIN
189620Medicare ID - Type Unspecified