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General NPI Number Information
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NPI Number | 1588651715
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Entity Type | Individual
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Provider Name | CARL RANDOLPH SHELTON MD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 201 MEDICAL VILLAGE DR
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City | EDGEWOOD
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State | KY
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Zip | 41017-3407
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Country | US
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Telephone | 407-681-2241
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Fax | 407-679-2779
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Provider Business Mailing Address
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Address Line | 6086 AUBURN CT
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City | BURLINGTON
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State | KY
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Zip | 41005-8022
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Country | US
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Telephone | 304-809-5312
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Fax | 859-918-6625
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 16669
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 45121
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 16669
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 45121
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License Number State | KY
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