Provider Demographics
NPI:1881029684
Name:STEVENS, MELISSA SHAUNDREA
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SHAUNDREA
Last Name:STEVENS
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 1:1811 W WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-4246
Mailing Address - Country:US
Mailing Address - Phone:229-395-2987
Mailing Address - Fax:
Practice Address - Street 1:1003 11TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1548
Practice Address - Country:US
Practice Address - Phone:229-809-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAB13-000640251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health