Provider Demographics
NPI:1770329005
Name:SHELTON, TALIA MICHELLE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:MICHELLE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 JOE KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9169
Mailing Address - Country:US
Mailing Address - Phone:704-360-2779
Mailing Address - Fax:
Practice Address - Street 1:170 JOE KNOX AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9169
Practice Address - Country:US
Practice Address - Phone:704-360-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-29972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer