Healthcare Provider Details

I. General information

NPI: 1992618516
Provider Name (Legal Business Name): TAMERA ANN SHELTON CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 COLLEGE AVE STE A2
MODESTO CA
95350-4046
US

IV. Provider business mailing address

1429 COLLEGE AVE STE A2
MODESTO CA
95350-4046
US

V. Phone/Fax

Practice location:
  • Phone: 209-238-9999
  • Fax: 209-522-5025
Mailing address:
  • Phone: 209-238-9999
  • Fax: 209-522-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number89483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: