Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101251254 | VA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 80380 | MA |
NPI | 1003807538 |
---|---|
Provider Name | Dr. Cornell Shelton |
First Address | Burke, VA 22015-3750 |
Second Address | Fredericksburg, VA 22401-3387 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 26/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003807538 | (05) | VA |
3172970 | (05) | MA |
F94729 | (02) |