Individual
GWENDOLYN SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1116 MILLIS AVE, BOONVILLE, IN 47601-2204
(812) 897-7404
Mailing address
1116 MILLIS AVE, BOONVILLE, IN 47601-2204
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01083878A
IN
208000000X
Pediatrics Physician
0420012043
VT
208000000X
Pediatrics Physician
2002-0294
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018027
—
VT
05
—
41835557
—
NM
Enumeration date
07/30/2006
Last updated
02/11/2025
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