Provider Demographics
NPI:1558525550
Name:MELVIN, SHELLEY MAREE (NP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MAREE
Last Name:MELVIN
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:21621 PLACERITA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1204
Mailing Address - Country:US
Mailing Address - Phone:805-432-2111
Mailing Address - Fax:661-253-2592
Practice Address - Street 1:2121 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2303
Practice Address - Country:US
Practice Address - Phone:844-414-9000
Practice Address - Fax:424-212-5925
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2016-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA10306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB0647YMedicare PIN