MEDICARE: ROBERT SHELTON JR.

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	261QA0600X	Adult Day Care Clinic/Center

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

General Provider Information

NPI Number	:	1740933316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SHELTON JR.

Provider Business Mailing Address
First Line	:	PO BOX 181698
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76096-1698
Country	:	US
Telephone Number	:	214-900-8360
Fax Number	:

Provider Business Practice Location Address
First Line	:	3504 MT VERNON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-2527
Country	:	US
Telephone Number	:	214-900-8360
Fax Number	:

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

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	02/02/2022

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Directions to “ ROBERT SHELTON JR. ” Practice Location

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