Provider Demographics
NPI:1083440481
Name:TODD, MELISSA SHEREE (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SHEREE
Last Name:TODD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-718-4390
Mailing Address - Fax:336-718-4399
Practice Address - Street 1:242 OAKSBURG DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-7709
Practice Address - Country:US
Practice Address - Phone:336-926-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2024-10-29
Deactivation Date:2024-08-29
Deactivation Code:
Reactivation Date:2024-09-11
Provider Licenses
StateLicense IDTaxonomies
NC5011755363L00000X
NC1818039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner