Healthcare Provider Details

I. General information

NPI: 1235019100
Provider Name (Legal Business Name): SHAELEAN AMANDA MELCHOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 E COLLEGE DR
MARSHALL MN
56258-2010
US

IV. Provider business mailing address

419 FREMONT ST S
LAKE BENTON MN
56149-1606
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-3236
  • Fax:
Mailing address:
  • Phone: 507-532-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2475733
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14375
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: