Provider Demographics
NPI:1114226321
Name:SHEPHARD, DANASHA MONIQUE
Entity Type:Individual
Prefix:MS
First Name:DANASHA
Middle Name:MONIQUE
Last Name:SHEPHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 TRIPLETT BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3421
Mailing Address - Country:US
Mailing Address - Phone:330-592-3128
Mailing Address - Fax:
Practice Address - Street 1:764 TRIPLETT BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3421
Practice Address - Country:US
Practice Address - Phone:330-592-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN140902164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse