Provider Demographics
NPI:1144489352
Name:SCOTT, SHELTON J (BS)
Entity type:Individual
Prefix:
First Name:SHELTON
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S SPRIGG
Mailing Address - Street 2:#2
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701
Mailing Address - Country:US
Mailing Address - Phone:573-651-4177
Mailing Address - Fax:573-651-3636
Practice Address - Street 1:20 S SPRIGG ST
Practice Address - Street 2:# 2
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6212
Practice Address - Country:US
Practice Address - Phone:573-651-4177
Practice Address - Fax:573-651-3636
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator