Provider Demographics
NPI:1154899573
Name:SHEDDEN, MELISSA (SLP INTERN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SHEDDEN
Suffix:
Gender:F
Credentials:SLP INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BOARDMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3722
Mailing Address - Country:US
Mailing Address - Phone:843-200-9600
Mailing Address - Fax:843-872-0511
Practice Address - Street 1:27 BOARDMAN RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3722
Practice Address - Country:US
Practice Address - Phone:843-200-9600
Practice Address - Fax:843-872-0511
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-03
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty