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NPI Code Detail

MEDICARE: MELANIE C SHANK

MEDICARE: MELANIE C SHANK
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
1103K00000XBehavior Analyst0-12-4479

General Provider Information

NPI Number : 1134493257
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELANIE C SHANK
Provider Business Mailing Address
First Line : 171 OAK SIDE CT
Second Line :
City : RICHMOND HILL
State : GA
Zip : 31324-5356
Country : US
Telephone Number : 860-559-8854
Fax Number :
Provider Business Practice Location Address
First Line : 740 E GENERAL STEWART WAY STE 103
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-2636
Country : US
Telephone Number : 877-321-2899
Fax Number : 877-540-0182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2012
Last Update Date : 03/31/2020

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Directions to “ MELANIE C SHANK ” Practice Location

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