Provider Demographics
NPI:1104794049
Name:SHEPARD, DEVARE ELISE (APN)
Entity type:Individual
Prefix:
First Name:DEVARE
Middle Name:ELISE
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 HIGHWAY 35 STE 304
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5900
Mailing Address - Country:US
Mailing Address - Phone:732-338-8948
Mailing Address - Fax:
Practice Address - Street 1:280 HIGHWAY 35 STE 304
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5900
Practice Address - Country:US
Practice Address - Phone:732-338-8948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1811601768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine