Provider Demographics
NPI:1578355913
Name:BURRUSS, SHELTON JR
Entity type:Individual
Prefix:MR
First Name:SHELTON
Middle Name:
Last Name:BURRUSS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W 7TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-2101
Mailing Address - Country:US
Mailing Address - Phone:270-742-0188
Mailing Address - Fax:
Practice Address - Street 1:123 W 7TH ST STE 104
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2101
Practice Address - Country:US
Practice Address - Phone:270-742-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach