Provider Demographics
NPI:1467992487
Name:SHEPPARD, RODNEY (STNA)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 EVA WALK
Mailing Address - Street 2:APT F
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-4404
Mailing Address - Country:US
Mailing Address - Phone:330-356-9440
Mailing Address - Fax:
Practice Address - Street 1:471 WHITE POND DRIVE
Practice Address - Street 2:APT 604
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320
Practice Address - Country:US
Practice Address - Phone:330-835-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH40165496061376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH106358300799Medicaid