Provider Demographics
NPI:1639566219
Name:SHEPARD, MELISSA (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 BILLINGSLEY RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3091
Mailing Address - Country:US
Mailing Address - Phone:704-577-3186
Mailing Address - Fax:704-626-2701
Practice Address - Street 1:300 BILLINGSLEY RD STE 108
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3091
Practice Address - Country:US
Practice Address - Phone:704-577-3186
Practice Address - Fax:704-626-2701
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD69832084P0800X
NC2019-010632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry