MEDICARE: SHELTON SANDERS 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

General Provider Information

NPI Number	:	1669076691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELTON SANDERS CCC-SLP

Provider Business Mailing Address
First Line	:	4205 ELKINS AVE # B
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3641
Country	:	US
Telephone Number	:	731-414-3614
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 ELKINS AVE # B
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3641
Country	:	US
Telephone Number	:	731-414-3614
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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Directions to “ SHELTON SANDERS CCC-SLP” Practice Location

Language	Start Address	Practice Location

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