Provider Demographics
NPI:1740097310
Name:SHELTON-MOSS, TIFFANY PETRISE
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:PETRISE
Last Name:SHELTON-MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-1207
Mailing Address - Country:US
Mailing Address - Phone:330-459-4813
Mailing Address - Fax:
Practice Address - Street 1:117 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-1207
Practice Address - Country:US
Practice Address - Phone:330-459-4813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care