Provider Demographics
NPI:1407567571
Name:MELLOR, SHELLEY L
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name:MELLOR
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 1:500 ABERNETHY RD STE 5
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1062
Mailing Address - Country:US
Mailing Address - Phone:503-568-2611
Mailing Address - Fax:
Practice Address - Street 1:500 ABERNETHY RD STE 5
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1062
Practice Address - Country:US
Practice Address - Phone:503-568-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1407498439390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program