Active NPI
Amanda Shelton, ATC
- Athletic Trainer
- Gresham, OR
National Provider Identifier
1629556451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 10161465
- Practice address
- 26000 SE Stark St
Gresham, OR 97030-3300 - Phone
- (503) 491-7350
- NPI assigned
- Aug 2, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 10161465 | OR | Primary |
Addresses
Primary practice location
26000 SE Stark St
Gresham, OR 97030-3300
Mailing address
1930 NW Front Ave Apt 212
Portland, OR 97209-1849
Phone (414) 699-7736
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
| License | State | Type | Specialty |
|---|---|---|---|
| 10161465 | OR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533168000000",
"number": "1629556451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1930 NW FRONT AVE APT 212",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972091849",
"telephone_number": "414-699-7736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26000 SE STARK ST",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303300",
"telephone_number": "503-491-7350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELTON",
"first_name": "AMANDA",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-02",
"last_updated": "2018-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "10161465",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.