Provider Demographics
NPI:1477763209
Name:SHEPHERD, SUTTON LYNN (MA)
Entity Type:Individual
Prefix:MS
First Name:SUTTON
Middle Name:LYNN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4309
Mailing Address - Country:US
Mailing Address - Phone:386-679-4429
Mailing Address - Fax:386-736-4717
Practice Address - Street 1:324 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4309
Practice Address - Country:US
Practice Address - Phone:386-679-4429
Practice Address - Fax:386-736-4717
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health