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General NPI Number Information
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NPI Number | 1285649749
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Entity Type | Individual
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Provider Name | GWENDOLYN SHELTON MD
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Gender | Female
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1116 MILLIS AVE
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City | BOONVILLE
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State | IN
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Zip | 47601-2204
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Country | US
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Telephone | 812-897-7404
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 MILLIS AVE
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City | BOONVILLE
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State | IN
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Zip | 47601-2204
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2002-0294
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0420012043
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01083878A
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License Number State | IN
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