Provider Demographics
NPI:1831777325
Name:SHELTON, JAMES (DAOM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3026
Mailing Address - Country:US
Mailing Address - Phone:401-573-9590
Mailing Address - Fax:
Practice Address - Street 1:148 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2130
Practice Address - Country:US
Practice Address - Phone:401-743-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist