Provider Demographics
NPI:1821572306
Name:SHELTON, ALLISON NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICOLE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:NICOLE
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5318 RANALLI DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9653
Mailing Address - Country:US
Mailing Address - Phone:724-449-9355
Mailing Address - Fax:
Practice Address - Street 1:5318 RANALLI DR
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9653
Practice Address - Country:US
Practice Address - Phone:724-449-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA007066363A00000X
PAMA060118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant