Provider Demographics
NPI:1689495020
Name:SHELTON, JAMEISHA
Entity type:Individual
Prefix:
First Name:JAMEISHA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G3498 MACKIN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-3216
Mailing Address - Country:US
Mailing Address - Phone:810-620-3147
Mailing Address - Fax:
Practice Address - Street 1:1452 W HUMPHREY AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-1029
Practice Address - Country:US
Practice Address - Phone:810-579-6619
Practice Address - Fax:810-645-9338
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy