Provider Demographics
NPI:1174687073
Name:SHEPARD, SCOTT
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 GREENVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2920
Mailing Address - Country:US
Mailing Address - Phone:703-451-3797
Mailing Address - Fax:
Practice Address - Street 1:5201 LEESBURG PIKE
Practice Address - Street 2:SKY 3, SUITE 1501
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3203
Practice Address - Country:US
Practice Address - Phone:703-681-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical