Healthcare Provider Details

I. General information

NPI: 1629708722
Provider Name (Legal Business Name): MELISSA TAYLOR SHADOIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N CARRIAGE PKWY
WICHITA KS
67208-4501
US

IV. Provider business mailing address

620 N CARRIAGE PKWY
WICHITA KS
67208-4501
US

V. Phone/Fax

Practice location:
  • Phone: 316-962-3100
  • Fax: 316-962-3164
Mailing address:
  • Phone: 316-962-3100
  • Fax: 316-962-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-11073
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: