Provider Demographics
NPI:1720606437
Name:SHELTON, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 LANCASTER DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3065 BRIGHTON 2ND ST # 1014
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7404
Practice Address - Country:US
Practice Address - Phone:844-359-8363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1043889967261QM2500X
CT1992372403261QM2500X
NJ1992372403261QM2500X
GARN195187363LF0000X
AZ289347363LF0000X
COC-APN.0004691-C-NP363LF0000X
DELG-0012307363LF0000X
FLAPRN11020413363LF0000X
CT14739363LF0000X
WAAP61407467363LF0000X
DCNP500003673363LF0000X
IL209026043363LF0000X
AZRNP289347363LF0000X
NY350772363LF0000X
MDAC005268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty