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General NPI Number Information
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NPI Number | 1174156715
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Entity Type | Individual
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Provider Name | MELINDA PEARL SHEPPARD CNA
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Gender | Female
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 5300 PATRON PLACE
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City | SUMMERVILLE
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State | SC
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Zip | 29485
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Country | US
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Telephone | 862-230-4894
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Fax |
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Provider Business Mailing Address
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Address Line | 534 S 11TH ST APT 1
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City | NEWARK
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State | NJ
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Zip | 07103-2397
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 9992889
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License Number State | SC
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