Provider Demographics
NPI:1588848030
Name:MELTON, SHARRON S
Entity Type:Individual
Prefix:MRS
First Name:SHARRON
Middle Name:S
Last Name:MELTON
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 1:10731 S BROKEN STIRRUP PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-9048
Mailing Address - Country:US
Mailing Address - Phone:520-574-0407
Mailing Address - Fax:
Practice Address - Street 1:10731 S BROKEN STIRRUP PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-9048
Practice Address - Country:US
Practice Address - Phone:520-574-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ564382171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ564382OtherAZOLCR