Healthcare Provider Details

I. General information

NPI: 1982265161
Provider Name (Legal Business Name): MATTHEW QUINN SHELTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 PROFESSIONAL WAY STE 2
PAYSON UT
84651-1680
US

IV. Provider business mailing address

1055 N 500 W ATTN CREDENTIALING
PROVO UT
84604-4305
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-4896
  • Fax: 18-465-4107
Mailing address:
  • Phone: 180-135-4822
  • Fax: 814-534-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT019600
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12951971-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: