Provider Demographics
NPI:1144333477
Name:SHAUM, MELANI P (MD)
Entity type:Individual
Prefix:
First Name:MELANI
Middle Name:P
Last Name:SHAUM
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 1:1515 E OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7092
Mailing Address - Country:US
Mailing Address - Phone:805-737-3300
Mailing Address - Fax:805-737-5795
Practice Address - Street 1:1213 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7041
Practice Address - Country:US
Practice Address - Phone:805-735-1155
Practice Address - Fax:805-737-1133
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45466207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG45466OtherMEDICAL LICENSE
CAW15185AOtherMEDICARE PTAN - FACILITY
CAW15185OtherMEDICARE PTAN - FACILITY
CAW15185OtherMEDICARE PTAN - FACILITY
CAAP1823548OtherDEA
CAA89817Medicare UPIN
CAWG45466CMedicare ID - Type Unspecified