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NPI Code Detail

MEDICARE: GWENDOLYN SHELTON MD

MEDICARE: GWENDOLYN SHELTON MD
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
1208000000XPediatrics Physician2002-0294NM
2208000000XPediatrics Physician0420012043VT
3208000000XPediatrics Physician01083878AIN

Other Identifiers

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

General Provider Information

NPI Number : 1285649749
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN SHELTON MD
Provider Business Mailing Address
First Line : 1116 MILLIS AVE
Second Line :
City : BOONVILLE
State : IN
Zip : 47601-2204
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1116 MILLIS AVE
Second Line :
City : BOONVILLE
State : IN
Zip : 47601-2204
Country : US
Telephone Number : 812-897-7404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2006
Last Update Date : 02/11/2025

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Directions to “ GWENDOLYN SHELTON MD” Practice Location

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