Provider Demographics
NPI:1467950980
Name:SHEPPARD DAVENPORT, JILL (MS, MPP, LN, LDN,CNS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SHEPPARD DAVENPORT
Suffix:
Gender:F
Credentials:MS, MPP, LN, LDN,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 HICKORY RIDGE RD SUITE 215
Mailing Address - Street 2:C/O HOLISTIC CHILD PSYCHIATRY
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044
Mailing Address - Country:US
Mailing Address - Phone:202-567-7783
Mailing Address - Fax:
Practice Address - Street 1:10801 HICKORY RIDGE RD SUITE 215
Practice Address - Street 2:C/O HOLISTIC CHILD PSYCHIATRY
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:202-567-7783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4347133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education