Doctor Name: | PETER D SHELTON |
NPI Number: | 1023043890 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | 000426 1 |
Business Practice Address: | 325 Meeting House Ln Bldg 2 Suite 301 Southampton, NY - 119685087 |
Business Phone Number: | 6312879477 |
Business Fax Number: | |
Mailing Address: | 325 Meeting House Ln Bldg 2, Suite 301 SOUTHAMPTON |
State: | NY |
Postal Code: | 119685087 |
Phone Number: | 6312879477 |
Fax Number: | |
NPI Enumeration Date: | 07/11/2006 |
NPI Last Update Date: | 03/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 000426 1 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |