Provider Demographics
NPI:1477031953
Name:SHEPARD, EVRIS (LPN)
Entity Type:Individual
Prefix:
First Name:EVRIS
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 ROBERTA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2724
Mailing Address - Country:US
Mailing Address - Phone:407-485-6491
Mailing Address - Fax:
Practice Address - Street 1:136 ROBERTA ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2724
Practice Address - Country:US
Practice Address - Phone:407-485-6491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298809-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherSOCIAL SECURITY