Individual
DIANE SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS SPECIAL ED
Contact information
Practice address
615 BLUEBILL LN, KISSIMMEE, FL 34759-4517
(646) 591-3048
Mailing address
615 BLUEBILL LN, KISSIMMEE, FL 34759-4517
(646) 591-3048
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
1053673681
FL
390200000X
Student in an Organized Health Care Education/Training Program
469681041
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174400000X
TAXONOMY
NY
05
—
222Q00000X
—
FL
Enumeration date
06/11/2012
Last updated
07/10/2024
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