Provider Demographics
NPI:1538787320
Name:SHELTON, TONI T (LMBT)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:T
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 CAMERON CREST CIR APT 422
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7349
Mailing Address - Country:US
Mailing Address - Phone:919-417-3695
Mailing Address - Fax:
Practice Address - Street 1:216 E CHATHAM ST STE 110
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3495
Practice Address - Country:US
Practice Address - Phone:919-466-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC618225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist