Provider Demographics
NPI:1447765722
Name:SHEPHERD, LATOYA LASHELLE
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:LASHELLE
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 1:214 N BECKMAN CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0417
Mailing Address - Country:US
Mailing Address - Phone:470-358-0737
Mailing Address - Fax:
Practice Address - Street 1:214 N BECKMAN CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0417
Practice Address - Country:US
Practice Address - Phone:470-358-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health