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General NPI Number Information
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NPI Number | 1285055772
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Entity Type | Individual
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Provider Name | BRYAN SHELTON
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Gender | Male
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Dates
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Enumeration Date | 12/30/2013
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 16834 113TH LN SE
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City | RENTON
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State | WA
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Zip | 98055-6505
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Country | US
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Telephone | 206-354-6939
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Fax |
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Provider Business Mailing Address
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Address Line | 16834 113TH LN SE
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City | RENTON
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State | WA
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Zip | 98055-6505
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Country | US
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Telephone | 206-354-6939
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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 | 2279P3900X
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Taxonomy Name | Neonatal/Pediatric Registered Respiratory Therapist
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License Number | RC2356
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License Number State | NV
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