Healthcare Provider Details

I. General information

NPI: 1114840105
Provider Name (Legal Business Name): LAVEENA SHELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 WYCKFIELD WAY
INDIANAPOLIS IN
46220-4040
US

IV. Provider business mailing address

5730 WYCKFIELD WAY
INDIANAPOLIS IN
46220-4040
US

V. Phone/Fax

Practice location:
  • Phone: 317-354-9487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number202403081772467
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: