Provider Demographics
NPI:1447720016
Name:SHELTON, MICHELLE ANGELINA (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGELINA
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 BROOKBEND CT
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-6137
Mailing Address - Country:US
Mailing Address - Phone:512-940-8531
Mailing Address - Fax:
Practice Address - Street 1:2460 N INTERSTATE HIGHWAY 35 E STE 285
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5286
Practice Address - Country:US
Practice Address - Phone:972-736-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty