Provider Demographics
NPI:1235246067
Name:SHEPARD-SMITH, ABBEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ABBEY
Middle Name:
Last Name:SHEPARD-SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 SHERIDAN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3409
Mailing Address - Country:US
Mailing Address - Phone:954-989-3600
Mailing Address - Fax:954-894-1884
Practice Address - Street 1:4600 SHERIDAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3409
Practice Address - Country:US
Practice Address - Phone:954-989-3600
Practice Address - Fax:954-894-1884
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004096103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73390Medicare ID - Type Unspecified