Healthcare Provider Details

I. General information

NPI: 1124432273
Provider Name (Legal Business Name): JUSTIN ALAN SHELTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

10100 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-2946
  • Fax: 503-571-2683
Mailing address:
  • Phone: 503-571-2946
  • Fax: 503-571-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO187426
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: