Provider Demographics
NPI:1225613664
Name:SHEPPHARD, TAMARA DENISE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DENISE
Last Name:SHEPPHARD
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 1:950 N EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-2212
Mailing Address - Country:US
Mailing Address - Phone:909-973-4885
Mailing Address - Fax:
Practice Address - Street 1:1515 W 190TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4319
Practice Address - Country:US
Practice Address - Phone:310-819-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst