Provider Demographics
NPI:1275624892
Name:SHEPHERD, MICHELLE F (MA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:F
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:590 LOUISIANA AVE
Mailing Address - Street 2:#2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1518
Mailing Address - Country:US
Mailing Address - Phone:718-963-8362
Mailing Address - Fax:718-630-3135
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-8362
Practice Address - Fax:718-630-3135
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001008231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist