Individual provider Active NPI

Mary Ellen Shelton, LCSW

  • Clinical Social Worker
  • Gainesville, FL
National Provider Identifier
1265631394
Registry record updated Feb 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW4650 Issued in FL
Practice address
4703 NW 53Rd Ave
Suite B-2
Gainesville, FL 32653-3415
Phone
(352) 380-0303
Fax
(352) 377-7275
NPI assigned
Jul 18, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 18, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW4650 FL Primary

Addresses

Primary practice location

4703 NW 53Rd Ave
Suite B-2
Gainesville, FL 32653-3415

Mailing address

4703 NW 53Rd Ave
Suite B-2
Gainesville, FL 32653-3415
Phone (352) 380-0303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
SW4650FLMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455753600000",
    "number": "1265631394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4703 NW 53RD AVE",
            "address_2": "SUITE B-2",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326533415",
            "telephone_number": "352-380-0303",
            "fax_number": "352-377-7275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4703 NW 53RD AVE",
            "address_2": "SUITE B-2",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326533415",
            "telephone_number": "352-380-0303",
            "fax_number": "352-377-7275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "MARY",
        "middle_name": "ELLEN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-18",
        "last_updated": "2016-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW4650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; 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.