1033583653 NPI number — SHELTON PROSTHETICS AND ORTHOTICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033583653 NPI number — SHELTON PROSTHETICS AND ORTHOTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELTON PROSTHETICS AND ORTHOTICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033583653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
617 COLONIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-0217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-520-0163
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 ASHTON DR
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28412-2575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-520-0163
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SHELTON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
SOUTHALL
Authorized Official Title or Position:
PROSTHETIST/ORTHOTIST
Authorized Official Telephone Number:
910-520-0163

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com