MEDICARE: SHELTON DURUISSEAU DR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1346551066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELTON DURUISSEAU DR.

Provider Business Mailing Address
First Line	:	4528 GRESHAM DR
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-7640
Country	:	US
Telephone Number	:	916-810-9910
Fax Number	:

Provider Business Practice Location Address
First Line	:	4528 GRESHAM DR
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-7640
Country	:	US
Telephone Number	:	916-810-9910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	06/28/2010

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Directions to “ SHELTON DURUISSEAU DR.” Practice Location

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