Provider Demographics
NPI:1356875447
Name:SHEPHERD, MELODY REENA
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:REENA
Last Name:SHEPHERD
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 1:1125 S LINDEN RD STE 500
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4069
Mailing Address - Country:US
Mailing Address - Phone:810-262-2150
Mailing Address - Fax:
Practice Address - Street 1:1125 S LINDEN RD STE 500
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4069
Practice Address - Country:US
Practice Address - Phone:810-262-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704194364163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management