Diane Shelton, MS SPECIAL ED

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

License

1053673681 Issued in FL

Practice address

615 Bluebill LN
Kissimmee, FL 34759-4517

Phone

(646) 591-3048

NPI assigned

Jun 11, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1053673681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 BLUEBILL LN",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347594517",
            "telephone_number": "646-591-3048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 BLUEBILL LN",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347594517",
            "telephone_number": "646-591-3048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "DIANE",
        "credential": "MS SPECIAL ED",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-11",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "469681041",
            "primary": false
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "FL",
            "license": "1053673681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "222Q00000X",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "174400000X",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Developmental Therapist in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Developmental Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.