Provider Demographics
NPI:1679667398
Name:SHELDON, MELODY LYNN (MA, CCC-SP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:LYNN
Last Name:SHELDON
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 N. SECOND
Mailing Address - Street 2:STE C
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2305
Mailing Address - Country:US
Mailing Address - Phone:541-267-5221
Mailing Address - Fax:541-267-5221
Practice Address - Street 1:490 N. SECOND
Practice Address - Street 2:STE C
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2305
Practice Address - Country:US
Practice Address - Phone:541-267-5221
Practice Address - Fax:541-267-5221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10886235Z00000X
CA7002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR089037Medicaid
OR047063Medicaid