Provider Demographics
NPI:1407187404
Name:SHEDD, NARA (LMT 5917)
Entity Type:Individual
Prefix:
First Name:NARA
Middle Name:
Last Name:SHEDD
Suffix:
Gender:F
Credentials:LMT 5917
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DARTMOUTH DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2219
Mailing Address - Country:US
Mailing Address - Phone:505-975-4823
Mailing Address - Fax:
Practice Address - Street 1:201 DARTMOUTH DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2219
Practice Address - Country:US
Practice Address - Phone:505-975-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5917225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist