Provider Demographics
NPI:1306877287
Name:SHELTON, BRENT DELEATH (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:DELEATH
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 1:6011 E WOODMEN RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2602
Mailing Address - Country:US
Mailing Address - Phone:719-591-6666
Mailing Address - Fax:719-573-0731
Practice Address - Street 1:6011 E WOODMEN RD
Practice Address - Street 2:SUITE 320
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2602
Practice Address - Country:US
Practice Address - Phone:719-591-6666
Practice Address - Fax:719-573-0731
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0037464207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01132881Medicaid
CO01132881Medicaid
399428Medicare ID - Type Unspecified