Provider Demographics
NPI:1306653779
Name:SHEPHERD, AMBER L
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
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 1:5409 TANGLEWOOD PINE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3194
Mailing Address - Country:US
Mailing Address - Phone:919-607-9390
Mailing Address - Fax:
Practice Address - Street 1:5409 TANGLEWOOD PINE LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3194
Practice Address - Country:US
Practice Address - Phone:919-607-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician