Provider Demographics
NPI:1053536987
Name:SHELTON, DEBORAH LOLLY (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LOLLY
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:LOLLY
Other - Last Name:ELKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6110 MESA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3737
Mailing Address - Country:US
Mailing Address - Phone:512-453-8414
Mailing Address - Fax:
Practice Address - Street 1:4615 SPICEWOOD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8507
Practice Address - Country:US
Practice Address - Phone:512-241-1420
Practice Address - Fax:512-241-1074
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK76112084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDS082471JMedicare UPIN