Provider Demographics
NPI:1730160474
Name:SHELTON, ROBERT R (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:SHELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 JOHNS HOPKINS DR
Practice Address - Street 2:ECU PSYCHIATRIC MEDICINE OUTPATIENT CENTER
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7225
Practice Address - Country:US
Practice Address - Phone:252-744-2900
Practice Address - Fax:252-744-3844
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2621103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045G6OtherBCBS NC
NC6000464Medicaid
NC6000697Medicaid
NC8819874CMedicare PIN
NC6000697Medicaid