Provider Demographics
NPI:1821375049
Name:CORNEL J SHELTON MD LLC
Entity type:Organization
Organization Name:CORNEL J SHELTON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORNELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-222-5925
Mailing Address - Street 1:157 FLEET ST
Mailing Address - Street 2:PH5
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1586
Mailing Address - Country:US
Mailing Address - Phone:413-222-5925
Mailing Address - Fax:
Practice Address - Street 1:157 FLEET ST
Practice Address - Street 2:PH5
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1586
Practice Address - Country:US
Practice Address - Phone:413-222-5925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063535208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty