Provider Demographics
NPI:1154311520
Name:SHELTON, LYDIA DUNAWAY (MSN,WHNP,FNP)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:DUNAWAY
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MSN,WHNP,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4023
Mailing Address - Country:US
Mailing Address - Phone:434-799-5190
Mailing Address - Fax:
Practice Address - Street 1:DANVILLE HEALTH DEPARTMENT
Practice Address - Street 2:326 TAYLOR DRIVE
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541
Practice Address - Country:US
Practice Address - Phone:434-799-5190
Practice Address - Fax:434-799-5022
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001069785163W00000X
VA0024069785363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ36475Medicare UPIN
VA00W261C01Medicare PIN
VA00W260P01Medicare PIN