Provider Demographics
NPI:1174574214
Name:SHELTON, MARK WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WAYNE
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 1:410 42ND AVE N STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3658
Mailing Address - Country:US
Mailing Address - Phone:615-329-7887
Mailing Address - Fax:615-781-3882
Practice Address - Street 1:393 WALLACE RD STE 301
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4834
Practice Address - Country:US
Practice Address - Phone:615-425-0550
Practice Address - Fax:615-833-8287
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0245792086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730870Medicaid
TN3083414Medicare ID - Type Unspecified
TNF83954Medicare UPIN