Healthcare Provider Details

I. General information

NPI: 1225155518
Provider Name (Legal Business Name): BEVERLY LYNN SHELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 MICHIGAN ST
BELLEFONTAINE OH
43311-2518
US

IV. Provider business mailing address

1165 MICHIGAN ST
BELLEFONTAINE OH
43311-2518
US

V. Phone/Fax

Practice location:
  • Phone: 937-592-0545
  • Fax:
Mailing address:
  • Phone: 937-592-0545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: