Provider Demographics
NPI:1649076688
Name:MELTON, SHELLY SAKURAKO
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:SAKURAKO
Last Name:MELTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 WASHINGTON AVE S STE 615
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2430
Mailing Address - Country:US
Mailing Address - Phone:720-850-2055
Mailing Address - Fax:
Practice Address - Street 1:7825 WASHINGTON AVE S STE 615
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55439-2430
Practice Address - Country:US
Practice Address - Phone:720-850-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist