Healthcare Provider Details

I. General information

NPI: 1295695724
Provider Name (Legal Business Name): SHELTON MAURICE ORGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 KINGSMILL PKWY
COLUMBUS OH
43229-1143
US

IV. Provider business mailing address

8044 MONTGOMERY RD STE 700
CINCINNATI OH
45236-2926
US

V. Phone/Fax

Practice location:
  • Phone: 614-907-5434
  • Fax: 614-939-2357
Mailing address:
  • Phone: 513-440-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCDCA.193852
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: