Healthcare Provider Details

I. General information

NPI: 1013743004
Provider Name (Legal Business Name): CLAIRE TR SHELTON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 LIMESTONE RD
WILMINGTON DE
19808-5408
US

IV. Provider business mailing address

5417 CRESTLINE RD
WILMINGTON DE
19808-3625
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-9494
  • Fax:
Mailing address:
  • Phone: 484-888-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberJ3-0000247
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: