Provider Demographics
NPI:1215934310
Name:SHELTON, STEVEN R (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:SHELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3554
Mailing Address - Country:US
Mailing Address - Phone:812-282-1888
Mailing Address - Fax:812-285-8392
Practice Address - Street 1:510 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3554
Practice Address - Country:US
Practice Address - Phone:812-282-1888
Practice Address - Fax:812-218-9318
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL500152084P0800X
KY247122084P0800X
IN010375562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2444451000OtherPASSPORT GROUP
KY65927857Medicaid
KY64870587Medicaid
KY6764OtherMEDICARE GROUP #
KYP00289126OtherRAILRAOD MEDICARE
000000056294OtherANTHEM GROUP
KY78903689Medicaid
KY82900176Medicaid
IN100076220AMedicaid
IN260033017OtherRAILROAD MEDICARE
INCG3623OtherRAILROAD MEDICARE GROUP #
IN100386460OtherINDIANA MEDICAID GROUP #
1063415297OtherPV GROUP NPI
KY2444452000OtherPASSPORT ADVANTAGE
000000042717OtherANTHEM
IN160780OtherMEDICARE GROUP
IN160860OtherMEDICARE GROUP #
50704000OtherMAGELLAN GROUP
KYCK2274OtherRAILROAD MEDICARE GROUP #
IN160780OtherMEDICARE GROUP
IN160780IMedicare ID - Type Unspecified
KY64870587Medicaid