Provider Demographics
NPI:1548021371
Name:SHELTON, IMISHA NIKOLE
Entity type:Individual
Prefix:
First Name:IMISHA
Middle Name:NIKOLE
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 1:1285 LONGLEAF DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5457
Mailing Address - Country:US
Mailing Address - Phone:214-296-7122
Mailing Address - Fax:
Practice Address - Street 1:1285 LONGLEAF DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-5457
Practice Address - Country:US
Practice Address - Phone:214-296-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP1600X
TXRBT-23-265169106S00000X
133N00000X, 133NN1002X, 171400000X, 171M00000X, 175T00000X, 372500000X, 372600000X, 374U00000X, 374K00000X, 171W00000X, 172A00000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No175L00000XOther Service ProvidersHomeopath