Provider Demographics
NPI:1174375174
Name:SHELTON, THOMAS (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:159 MARGARET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1874
Mailing Address - Country:US
Mailing Address - Phone:518-314-3939
Mailing Address - Fax:
Practice Address - Street 1:159 MARGARET ST STE 100
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1874
Practice Address - Country:US
Practice Address - Phone:518-314-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program