Provider Demographics
NPI:1437217445
Name:SHEPPERSON, VANCE LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VANCE
Middle Name:LEE
Last Name:SHEPPERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4938
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-4938
Mailing Address - Country:US
Mailing Address - Phone:808-329-7176
Mailing Address - Fax:808-326-1279
Practice Address - Street 1:1619 E CHAPMAN
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3132
Practice Address - Country:US
Practice Address - Phone:714-992-4240
Practice Address - Fax:714-992-5259
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6775103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP6775AMedicare ID - Type UnspecifiedPROVIDER NUMBER