Provider Demographics
NPI:1285745794
Name:SHELTON, WILLIAM RYAN (NMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RYAN
Last Name:SHELTON
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 KANOA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2426
Mailing Address - Country:US
Mailing Address - Phone:785-424-0841
Mailing Address - Fax:
Practice Address - Street 1:15 KANOA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2426
Practice Address - Country:US
Practice Address - Phone:785-424-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1243175F00000X
CAND-362175F00000X
HI203175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath