MEDICARE: DR. SHARON L SHELTON DO

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	207Q00000X	Family Medicine Physician	OS8303	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174594295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON L SHELTON DO

Provider Business Mailing Address
First Line	:	2460 OLD MOULTRIE RD STE 2
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-4198
Country	:	US
Telephone Number	:	904-293-0299
Fax Number	:

Provider Business Practice Location Address
First Line	:	2984 S RIDGEWOOD AVE STE A
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32141-7527
Country	:	US
Telephone Number	:	386-428-4640
Fax Number	:

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	04/22/2020

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Directions to “ DR. SHARON L SHELTON DO” Practice Location

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