Individual
MELODY SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3990 JOHN R ST, DETROIT, MI 48201-2018
(313) 745-8040
Mailing address
4967 CROOKS RD, STE 130, TROY, MI 48098-5801
(248) 952-1601
(248) 952-1614
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601004921
MI
Other
Enumeration date
03/29/2007
Last updated
07/29/2015
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