Provider Demographics
NPI:1124074489
Name:SHELTON, MICHELLE ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ALEXANDER
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5146 STAGE RD 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3139
Mailing Address - Country:US
Mailing Address - Phone:901-377-3593
Mailing Address - Fax:901-377-8068
Practice Address - Street 1:5146 STAGE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-3139
Practice Address - Country:US
Practice Address - Phone:901-377-3475
Practice Address - Fax:901-377-8068
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33828207Q00000X
ARE-6733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3162048OtherBLUE CROSS IDENTIFICATION
TN3721290Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
TN3856078Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE PROVI
TN3162048OtherBLUE CROSS IDENTIFICATION