Provider Demographics
NPI:1205185162
Name:SHEPPARD, MELLANIE (IBCLC)
Entity type:Individual
Prefix:
First Name:MELLANIE
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 SOUTHRIDGE CT
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4393
Mailing Address - Country:US
Mailing Address - Phone:817-504-6947
Mailing Address - Fax:
Practice Address - Street 1:1237 SOUTHRIDGE CT
Practice Address - Street 2:SUITE 208
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4393
Practice Address - Country:US
Practice Address - Phone:817-504-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN