Provider Demographics
NPI:1528256716
Name:SHELTON, DONNA LEIGH (P A)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEIGH
Last Name:SHELTON
Suffix:
Gender:F
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3715 GUARDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4323
Mailing Address - Country:US
Mailing Address - Phone:252-222-3144
Mailing Address - Fax:252-222-3358
Practice Address - Street 1:3715 GUARDIAN AVE
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4323
Practice Address - Country:US
Practice Address - Phone:252-222-3144
Practice Address - Fax:252-222-3358
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant