Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 143706 | NY |
NPI | 1720075617 |
---|---|
Provider Name | George T Shelton |
First Address | Schenectady, NY 12308-2104 |
Second Address | Schenectady, NY 12308-2104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 01/10/2008 |