Provider Demographics
NPI:1730697327
Name:SHELTON MEDICAL SERVICES,INC
Entity type:Organization
Organization Name:SHELTON MEDICAL SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRETELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMANEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-801-0218
Mailing Address - Street 1:3525 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4015
Mailing Address - Country:US
Mailing Address - Phone:786-801-0218
Mailing Address - Fax:786-353-9125
Practice Address - Street 1:3525 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4015
Practice Address - Country:US
Practice Address - Phone:786-801-0218
Practice Address - Fax:786-353-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QP2000X, 208D00000X, 261QP2000X, 251S00000X
FLHCC10414261QM0801X, 207Q00000X, 261QM0801X
FL363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL844018529OtherAHCA LICENSE
FL844018529OtherAHCA LICENSE