Provider Demographics
NPI:1639496144
Name:MELTON, SHARIDA J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHARIDA
Middle Name:J
Last Name:MELTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 SW LANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6799
Mailing Address - Country:US
Mailing Address - Phone:503-582-1014
Mailing Address - Fax:
Practice Address - Street 1:6607 SW LANDOVER DR
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6799
Practice Address - Country:US
Practice Address - Phone:503-582-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1854103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist