Provider Demographics
NPI:1225210164
Name:WEBB, SHEPPARD (MD)
Entity Type:Individual
Prefix:
First Name:SHEPPARD
Middle Name:
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2634
Mailing Address - Country:US
Mailing Address - Phone:631-371-1410
Mailing Address - Fax:631-938-9145
Practice Address - Street 1:325 MEETING HOUSE LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5087
Practice Address - Country:US
Practice Address - Phone:631-371-1410
Practice Address - Fax:631-938-9145
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204395208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD432102OtherMEDICAL LICENSE