MEDICARE: MS. NICOLE OCTAVIA SHELTON MS,CCC,SLP

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	235Z00000X	Speech-Language Pathologist	SLP013662	GA

General Provider Information

NPI Number	:	1417825506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE OCTAVIA SHELTON MS,CCC,SLP

Provider Business Mailing Address
First Line	:	971 ESTES DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-5001
Country	:	US
Telephone Number	:	267-243-5652
Fax Number	:

Provider Business Practice Location Address
First Line	:	971 ESTES DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-5001
Country	:	US
Telephone Number	:	267-243-5652
Fax Number	:

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

Provider Enumeration Date	:	10/29/2025
Last Update Date	:	10/29/2025

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