Healthcare Provider Details

I. General information

NPI: 1578045183
Provider Name (Legal Business Name): SHELTON MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3383 NW 7TH ST STE 308
MIAMI FL
33125-4140
US

IV. Provider business mailing address

3383 NW 7TH ST STE 308
MIAMI FL
33125-4140
US

V. Phone/Fax

Practice location:
  • Phone: 786-801-0218
  • Fax: 786-353-9125
Mailing address:
  • Phone: 786-801-0218
  • Fax: 786-353-9125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YORDANKYS GARCIA-COLUMBIE
Title or Position: PRESIDENT
Credential:
Phone: 908-494-3264