Provider Demographics
NPI:1861786519
Name:SHANNON, MELISSA CHASE (NP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CHASE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:TUTTLE
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN NP
Mailing Address - Street 1:1600 PERIMETER PARK DR
Mailing Address - Street 2:SUITE #225
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 S CAMERON ST
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2505
Practice Address - Country:US
Practice Address - Phone:919-732-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-29
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87166363LF0000X
CT02-647371363LF0000X
VT101-0021041363LF0000X
MA052782363LF0000X
NC241346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTONP0290Medicaid
VT05319758OtherBLUE SHIELD
VTNP0290Medicare PIN
VTONP0290Medicaid