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NPI Code Detail

MEDICARE: MELISIA SHANKLIN

MEDICARE: MELISIA SHANKLIN
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
1101YM0800XMental Health Counselor
2172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1811388168
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISIA SHANKLIN
Provider Business Mailing Address
First Line : 1969 TATE ST
Second Line : C204
City : EAST PALO ALTO
State : CA
Zip : 94303-2578
Country : US
Telephone Number : 650-817-9070
Fax Number : 650-246-3838
Provider Business Practice Location Address
First Line : 505 CYPRESS AVE
Second Line :
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-2922
Country : US
Telephone Number : 650-817-9070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2015
Last Update Date : 07/10/2020

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Directions to “ MELISIA SHANKLIN ” Practice Location

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