Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD040123 | DC |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | P3551 | TX |
NPI | 1487811808 |
---|---|
Provider Name | Dr. Shelton Andre Mckenzie |
First Address | Washington, DC 20060-0001 |
Second Address | Washington, DC 20060-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 25/10/2019 |