Healthcare Provider Details

I. General information

NPI: 1760533491
Provider Name (Legal Business Name): JOHN S SHELTON CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 ASHTON DR STE 201
WILMINGTON NC
28412-2486
US

IV. Provider business mailing address

2800 ASHTON DR STE 201
WILMINGTON NC
28412-2486
US

V. Phone/Fax

Practice location:
  • Phone: 910-218-2240
  • Fax: 910-399-5523
Mailing address:
  • Phone: 910-218-2240
  • Fax: 910-399-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: