Provider Demographics
NPI:1073307690
Name:SHELTON, ELVIN
Entity type:Individual
Prefix:
First Name:ELVIN
Middle Name:
Last Name:SHELTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-1817
Mailing Address - Country:US
Mailing Address - Phone:937-728-7351
Mailing Address - Fax:
Practice Address - Street 1:274 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-1817
Practice Address - Country:US
Practice Address - Phone:937-728-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker