Melissa Shepard, MD, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MELISSA SHEPARD, MD, LLC

Practice address

65 Duke St Ste 107
Prince Frederick, MD 20678-6128

Phone

(704) 274-2219

Fax

(704) 582-7160

NPI assigned

Mar 21, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Martha Montjoy Kearse

Title

Vice President

Phone

(704) 274-2219

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1760131361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4117 PARK RD # 12235",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282092214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 DUKE ST STE 107",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206786128",
            "telephone_number": "704-274-2219",
            "fax_number": "704-582-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELISSA SHEPARD, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-21",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "KEARSE",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "MONTJOY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "704-274-2219"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.