Gwendolyn Shelton, MD
Individual provider Active NPI Pediatrics Physician · Boonville, IN
NPI 1285649749 · NPPES record last updated Feb 11, 2025
Key facts
- NPI
- 1285649749
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 01083878A (IN)
- Practice address
- 1116 Millis Ave
Boonville, IN 47601-2204 - Phone
- (812) 897-7404
- NPI assigned
- Jul 30, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0420012043 | VT | MD | Pediatrics Physician |
Interoperability endpoints
- gwendolyn.shelton.1@7598.direct.athenahealth.com
- gwendolyn.shelton.2@7598.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2002-0294 | NM | |
| Pediatrics Physician | 208000000X | 0420012043 | VT | |
| Pediatrics Physician | 208000000X | 01083878A | IN | Yes |
Addresses
Primary practice location
1116 Millis Ave
Boonville, IN 47601-2204
Mailing address
1116 Millis Ave
Boonville, IN 47601-2204
Other practice location 1
246 Granger Rd
Suite 1
Berlin, VT 05602-0000
Phone (802) 371-5950
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41835557 | Medicaid | NM | |
| 1018027 | Medicaid | VT |
Other names
- Gwendolyn S Lattimore
Other providers in Boonville, IN
- Christie M Reagan
- Onyekachi John Robert-Eze
- Sarah Elizabeth Salee
- Natalie Sauls
- Paul Sepp-Gumbert
- April Sherman
- Stephen R Shoemaker
- Jacqueline Small
- Southern Indiana Resource Solutions, Inc.
- Southern Indiana Resource Solutions, Inc.
All providers in Boonville, IN · Pediatrics Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.