Provider Demographics
NPI:1073368270
Name:CAPERTON, SHELIA ROSECHELL
Entity type:Individual
Prefix:
First Name:SHELIA
Middle Name:ROSECHELL
Last Name:CAPERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9043 MERCURY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-1129
Mailing Address - Country:US
Mailing Address - Phone:317-200-5764
Mailing Address - Fax:
Practice Address - Street 1:1717 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2733
Practice Address - Country:US
Practice Address - Phone:317-280-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBC205017831744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management