Doctor Name: | MRS. SANDRA L SHEPHERD |
NPI Number: | 1457391609 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.A. |
License Number: | PA9101579 |
Business Practice Address: | 1222 S Orange Ave Orlando, FL - 328061215 |
Business Phone Number: | 4073515384 |
Business Fax Number: | 4074450321 |
Mailing Address: | 1222 S Orange Ave, ORLANDO |
State: | FL |
Postal Code: | 328061215 |
Phone Number: | 4073515384 |
Fax Number: | 4074450321 |
NPI Enumeration Date: | 06/07/2006 |
NPI Last Update Date: | 07/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA9101579 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |