Provider Demographics
NPI:1114796620
Name:SHEPHERD, MELANIE J
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:SHEPHERD
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 1:550 COUNTY ROAD 3565
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-8503
Mailing Address - Country:US
Mailing Address - Phone:409-377-4971
Mailing Address - Fax:
Practice Address - Street 1:452 COUNTY ROAD 4485
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:TX
Practice Address - Zip Code:77664-6576
Practice Address - Country:US
Practice Address - Phone:409-617-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider