MEDICARE: MELISSA MARIE SHEPHERD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	12885	CA

General Provider Information

NPI Number	:	1023590148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MARIE SHEPHERD

Provider Business Mailing Address
First Line	:	UCLA 200 MEDICAL PLAZA SUITE 540
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1613
Country	:	US
Telephone Number	:	310-825-8551
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MEDICAL PLAZA SUITE 540
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1613
Country	:	US
Telephone Number	:	310-825-8551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	02/01/2021

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Directions to “ MELISSA MARIE SHEPHERD ” Practice Location

Language	Start Address	Practice Location

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