Healthcare Provider Details

I. General information

NPI: 1730697327
Provider Name (Legal Business Name): SHELTON MEDICAL SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 NW 7TH ST
MIAMI FL
33125-4015
US

IV. Provider business mailing address

3525 NW 7TH ST
MIAMI FL
33125-4015
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 State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberHCC10414
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRETELL KAMANEL
Title or Position: PRESIDENT
Credential:
Phone: 786-801-0218