Provider Demographics
NPI:1720797301
Name:SHELTON, FALLON PAGE (APRN)
Entity Type:Individual
Prefix:MS
First Name:FALLON
Middle Name:PAGE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2553 MASON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6498
Mailing Address - Country:US
Mailing Address - Phone:813-940-6046
Mailing Address - Fax:866-451-4607
Practice Address - Street 1:3912 W BAY VILLA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1222
Practice Address - Country:US
Practice Address - Phone:727-249-7676
Practice Address - Fax:833-500-1422
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023017363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116748700Medicaid