Provider Demographics
NPI:1194568725
Name:SHELTON, PARISA (CMT AND CQP)
Entity type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:CMT AND CQP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E OLIVE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1849
Mailing Address - Country:US
Mailing Address - Phone:408-921-5179
Mailing Address - Fax:
Practice Address - Street 1:150 E OLIVE AVE STE 107
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1849
Practice Address - Country:US
Practice Address - Phone:408-921-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X, 225700000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist