Provider Demographics
NPI:1285731000
Name:SHELTON, SUZANNE H (PHD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:H
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15446 BEL RED RD
Mailing Address - Street 2:STE 430
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:425-881-6611
Mailing Address - Fax:425-657-0748
Practice Address - Street 1:15446 BEL RED RD
Practice Address - Street 2:STE 430
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-881-6611
Practice Address - Fax:425-657-0748
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPSY1818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00197948Medicaid
WASH0285OtherREGENCE RIDER