Provider Demographics
NPI:1164566980
Name:SHEPHERD, MELANIE (MA, MED)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-1418
Mailing Address - Country:US
Mailing Address - Phone:302-875-6100
Mailing Address - Fax:
Practice Address - Street 1:1160 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1418
Practice Address - Country:US
Practice Address - Phone:302-875-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE67178103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool