Provider Demographics
NPI:1013966423
Name:HENDERSON, MELINDA SHAW (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:SHAW
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MELINDA
Other - Middle Name:PATRICIA
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:926 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3614
Mailing Address - Country:US
Mailing Address - Phone:615-436-9060
Mailing Address - Fax:615-235-9725
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3614
Practice Address - Country:US
Practice Address - Phone:615-436-9060
Practice Address - Fax:615-235-9725
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101269980207R00000X
IAMD-46979207R00000X
FLME145469207R00000X
TXS7231207R00000X
KS04-44655207R00000X
TN39361207RG0300X, 207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3327126Medicaid
KS201357160AMedicaid
DE250696062Medicaid
VA1013966423Medicaid
HI001422Medicaid
FL109478800Medicaid
NC1013966423Medicaid
IL1013966423Medicaid
TX422491701Medicaid
NM98639757Medicaid
MI1013966423Medicaid
PA1040492810001Medicaid
KY64095060Medicaid
TN39361OtherMEDICAL LICENSE
IA0131691Medicaid
OH0425399Medicaid
MA110171810AMedicaid