Healthcare Provider Details

I. General information

NPI: 1598621179
Provider Name (Legal Business Name): AKISHA SHELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SWAIN CT APT 101
COVINGTON KY
41011-1063
US

IV. Provider business mailing address

22 SWAIN CT APT 101
COVINGTON KY
41011-1063
US

V. Phone/Fax

Practice location:
  • Phone: 513-716-4293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.007286
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: