Provider Demographics
NPI:1811103328
Name:SHELTON, ROLAND E JR (MSW)
Entity type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:E
Last Name:SHELTON
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2909
Mailing Address - Country:US
Mailing Address - Phone:610-394-4629
Mailing Address - Fax:
Practice Address - Street 1:304 SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2909
Practice Address - Country:US
Practice Address - Phone:610-394-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker