Provider Demographics
NPI:1144631565
Name:SHELTON, SARAH (MD)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 GREENBRIAR CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2191
Mailing Address - Country:US
Mailing Address - Phone:423-302-7127
Mailing Address - Fax:
Practice Address - Street 1:1928 ALCOA HWY STE 118
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1540
Practice Address - Country:US
Practice Address - Phone:865-305-9306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN626001636OtherPARENT ORGANIZATION TIN