Provider Demographics
NPI:1225723273
Name:SHEPHERD, ROBERTA ANN
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ANN
Last Name:SHEPHERD
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 1:4648 AIRWAY RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1333
Mailing Address - Country:US
Mailing Address - Phone:937-253-0295
Mailing Address - Fax:
Practice Address - Street 1:4648 AIRWAY RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-1333
Practice Address - Country:US
Practice Address - Phone:937-253-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion