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NPI Code Detail

MEDICARE: LINDSAY SHELTON

MEDICARE:   LINDSAY  SHELTON
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
1390200000XStudent in an Organized Health Care Education/Training Program101780472SC

General Provider Information

NPI Number : 1386031516
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDSAY SHELTON
Provider Business Mailing Address
First Line : 4812 NATIONAL DR
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-7211
Country : US
Telephone Number : 843-602-2073
Fax Number :
Provider Business Practice Location Address
First Line : 4812 NATIONAL DR
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-7211
Country : US
Telephone Number : 843-602-2073
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2015
Last Update Date : 04/26/2015

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Directions to “ LINDSAY SHELTON ” Practice Location

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