Provider Demographics
NPI:1497920052
Name:MELLETTE, SHERYL EILEEN (MS, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:EILEEN
Last Name:MELLETTE
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:EILEEN
Other - Last Name:HARTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:512-454-0392
Mailing Address - Fax:512-454-1233
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-454-0392
Practice Address - Fax:512-454-1233
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50828231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80777AOtherBCBS-HCAENT
TX80776AOtherBCBS-AENTC
TX80776AOtherBCBS-AENTC
TX80777AOtherBCBS-HCAENT