Provider Demographics
NPI:1831305119
Name:SHOEMAKER, MELINDA A (PHD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:A
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 210C
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-368-0026
Mailing Address - Fax:561-368-0016
Practice Address - Street 1:7301 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 210C
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-368-0026
Practice Address - Fax:561-368-0016
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23187101YA0400X
FL0002461101YM0800X
FL00773103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy