Provider Demographics
NPI:1184996407
Name:SHARP, MELANIE TRENISE
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:TRENISE
Last Name:SHARP
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 1:17421 ANNCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-4212
Mailing Address - Country:US
Mailing Address - Phone:313-283-7238
Mailing Address - Fax:
Practice Address - Street 1:17421 ANNCHESTER RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4212
Practice Address - Country:US
Practice Address - Phone:313-283-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010868731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical