Provider Demographics
NPI:1740478700
Name:SHIMPANO, MELODY
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:SHIMPANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:8300 FM 1960 RD W STE 450
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5699
Mailing Address - Country:US
Mailing Address - Phone:832-291-2486
Mailing Address - Fax:
Practice Address - Street 1:8300 FM 1960 RD W STE 450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5699
Practice Address - Country:US
Practice Address - Phone:832-291-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX452783909Medicare Oscar/Certification