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General NPI Number Information
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NPI Number | 1023043890
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Entity Type | Individual
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Provider Name | PETER D SHELTON PA
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 325 MEETING HOUSE LN BLDG 2 SUITE 301
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5087
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Country | US
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Telephone | 631-287-9477
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Fax |
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Provider Business Mailing Address
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Address Line | 325 MEETING HOUSE LN BLDG 2 SUITE 301
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5087
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Country | US
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Telephone | 631-287-9477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 000426 1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 000426 2
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License Number State | NY
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