Provider Demographics
NPI:1033563580
Name:SHEPARD, AMBER Y (MD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:Y
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 STATE ROAD 60 E STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4302
Mailing Address - Country:US
Mailing Address - Phone:863-676-8237
Mailing Address - Fax:863-676-8207
Practice Address - Street 1:1255 HIGHWAY 60 E STE 500
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853
Practice Address - Country:US
Practice Address - Phone:863-676-8237
Practice Address - Fax:863-676-8207
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine