Provider Demographics
NPI:1528526431
Name:SHENKER, MELODY WHEATON (CRNP)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:WHEATON
Last Name:SHENKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 ST MARK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HURTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:36860-3040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1441 ST MARK CHURCH RD
Practice Address - Street 2:
Practice Address - City:HURTSBORO
Practice Address - State:AL
Practice Address - Zip Code:36860-3040
Practice Address - Country:US
Practice Address - Phone:229-894-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-10
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN218073163W00000X
AL1-175013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse