Provider Demographics
NPI:1154394872
Name:SHELTON, KELLY SUE (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:SUE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1910 COCHRAN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1203
Mailing Address - Country:US
Mailing Address - Phone:412-531-2902
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:4151 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:PA
Practice Address - Zip Code:15340-1439
Practice Address - Country:US
Practice Address - Phone:724-356-2273
Practice Address - Fax:724-356-2585
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA001245L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS38545Medicare UPIN