Provider Demographics
NPI:1427099373
Name:BISCETTE, SHAN MELISSA (MD)
Entity type:Individual
Prefix:
First Name:SHAN
Middle Name:MELISSA
Last Name:BISCETTE
Suffix:
Gender:F
Credentials:MD
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 VAIL AVE
Practice Address - Street 2:STE 360
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1248
Practice Address - Country:US
Practice Address - Phone:704-304-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-00165207V00000X
KY43587207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000669382OtherANTHEM PSC
KY50029461OtherPASSPORT & ADVANTAGE FOUNDATION PCP#
KY7100126470Medicaid
KY50029462OtherPASSPORT & ADVANTAGE FOUNDATION SPECIALIST #
KY7945517OtherAETNA
KY000000669272OtherANTHEM FOUNDATION #
IN200989200Medicaid
KY50039463OtherPASSPORT & ADVANTAGE PSC SPECIALIST #
KY000000669272OtherANTHEM FOUNDATION #
KY50029461OtherPASSPORT & ADVANTAGE FOUNDATION PCP#
KYP400018695Medicare PIN