Provider Demographics
NPI:1780967059
Name:SHEAR, MELODY DAWN (RN)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:DAWN
Last Name:SHEAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 PIMLICO
Mailing Address - Street 2:APT. 1B
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-8253
Mailing Address - Country:US
Mailing Address - Phone:937-723-9186
Mailing Address - Fax:937-723-9186
Practice Address - Street 1:860 PIMLICO
Practice Address - Street 2:APT. 1B
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-8253
Practice Address - Country:US
Practice Address - Phone:937-723-9186
Practice Address - Fax:937-723-9186
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH365202163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH365202OtherOHIO BOARD OF NURSING