Healthcare Provider Details

I. General information

NPI: 1407646839
Provider Name (Legal Business Name): DALTON SHEVLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 CALLE AMANECER STE 115
SAN CLEMENTE CA
92673-6226
US

IV. Provider business mailing address

1631 DOHENY WAY
DANA POINT CA
92629-5926
US

V. Phone/Fax

Practice location:
  • Phone: 194-920-7360
  • Fax:
Mailing address:
  • Phone: 513-462-1687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: