Provider Demographics
NPI:1841962669
Name:SHELLEY, MALINDA K (NP)
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:K
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:K
Other - Last Name:DIRIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10101 ERNST RD STE 1200
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:IN
Practice Address - Zip Code:46783-9711
Practice Address - Country:US
Practice Address - Phone:260-234-5400
Practice Address - Fax:260-234-5410
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011971A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300058858Medicaid