Provider Demographics
NPI:1952099848
Name:SHELTON, ALISHA GABRIELLE
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:GABRIELLE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5721
Mailing Address - Country:US
Mailing Address - Phone:916-442-4985
Mailing Address - Fax:916-442-1029
Practice Address - Street 1:2100 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5721
Practice Address - Country:US
Practice Address - Phone:916-442-4985
Practice Address - Fax:916-442-1029
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-TKJMXN175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist