Provider Demographics
NPI:1780328906
Name:GRAY, SHELTON JAMES
Entity type:Individual
Prefix:
First Name:SHELTON
Middle Name:JAMES
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 N MAIN ST UNIT 408
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-1693
Mailing Address - Country:US
Mailing Address - Phone:302-245-8843
Mailing Address - Fax:
Practice Address - Street 1:644 N MAIN ST UNIT 408
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1693
Practice Address - Country:US
Practice Address - Phone:302-245-8843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer