MEDICARE: DR. ANGELA JANE SHELTON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1383	TN

General Provider Information

NPI Number	:	1073627816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA JANE SHELTON PHD

Provider Business Mailing Address
First Line	:	106 PINNACLE DR
Second Line	:	SUITE 106
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-6602
Country	:	US
Telephone Number	:	423-525-3771
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 PINNACLE DR
Second Line	:	SUITE 106
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-6602
Country	:	US
Telephone Number	:	423-525-3771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	05/31/2013

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