Healthcare Provider Details

I. General information

NPI: 1487075453
Provider Name (Legal Business Name): MELISSA VIOLA SHINER PHARMD CGP BCPP MHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

5 LAKE SHORE DR
FLEETWOOD PA
19522-8504
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5800
  • Fax:
Mailing address:
  • Phone: 484-769-1253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP046286L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRP046286L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: