Provider Demographics
NPI:1326358086
Name:SHEPHERD, DAVIA HYACINTH (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVIA
Middle Name:HYACINTH
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 UPSON PL
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1116
Mailing Address - Country:US
Mailing Address - Phone:203-695-1489
Mailing Address - Fax:
Practice Address - Street 1:21 UPSON PL
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1116
Practice Address - Country:US
Practice Address - Phone:203-695-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor