Provider Demographics
NPI:1285055772
Name:SHELTON, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRYAN
Other - Middle Name:
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RRT
Mailing Address - Street 1:16834 113TH LN SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6505
Mailing Address - Country:US
Mailing Address - Phone:206-354-6939
Mailing Address - Fax:
Practice Address - Street 1:16834 113TH LN SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6505
Practice Address - Country:US
Practice Address - Phone:206-354-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRC23562279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics