Healthcare Provider Details

I. General information

NPI: 1285055772
Provider Name (Legal Business Name): BRYAN SHELTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRYAN SHELTON RRT

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16834 113TH LN SE
RENTON WA
98055-6505
US

IV. Provider business mailing address

16834 113TH LN SE
RENTON WA
98055-6505
US

V. Phone/Fax

Practice location:
  • Phone: 206-354-6939
  • Fax:
Mailing address:
  • Phone: 206-354-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License NumberRC2356
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: