Provider Demographics
NPI:1740035765
Name:MELTON, SHAYE LYNNETTE
Entity type:Individual
Prefix:
First Name:SHAYE
Middle Name:LYNNETTE
Last Name:MELTON
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 1:825 W 91ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-3614
Mailing Address - Country:US
Mailing Address - Phone:918-519-0425
Mailing Address - Fax:
Practice Address - Street 1:825 W 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-3614
Practice Address - Country:US
Practice Address - Phone:918-519-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist