Provider Demographics
NPI:1417785841
Name:SHELTON, TREVOR LEE (NP)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:LEE
Last Name:SHELTON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 KINGSRIDGE DR STE 106
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1632
Mailing Address - Country:US
Mailing Address - Phone:937-813-4485
Mailing Address - Fax:
Practice Address - Street 1:8940 KINGSRIDGE DR STE 106
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1632
Practice Address - Country:US
Practice Address - Phone:937-813-4485
Practice Address - Fax:937-813-4576
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH453039163W00000X
OH0037170363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse