Provider Demographics
NPI:1053397786
Name:SANDS, MELODY E (NP)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:E
Last Name:SANDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6845 RAMA DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1707
Practice Address - Country:US
Practice Address - Phone:317-964-5200
Practice Address - Fax:317-964-5300
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000107A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01210568OtherRAILROAD MEDICARE
INP01210568OtherRAILROAD MEDICARE
INS58513Medicare UPIN
IN065910QMedicare ID - Type Unspecified