Provider Demographics
NPI:1285011221
Name:SHEPHERD, EMILY SUNAVY (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SUNAVY
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 KELLER DR APT 117
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1016
Mailing Address - Country:US
Mailing Address - Phone:714-907-6370
Mailing Address - Fax:
Practice Address - Street 1:2800 KELLER DR APT 117
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1016
Practice Address - Country:US
Practice Address - Phone:714-907-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist