Provider Demographics
NPI:1518025477
Name:SHEPARD-LEWIS, JACQUELINE CHRISTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:CHRISTINA
Last Name:SHEPARD-LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2030
Mailing Address - Country:US
Mailing Address - Phone:301-431-2721
Mailing Address - Fax:301-431-4687
Practice Address - Street 1:7070 SAMUEL MORSE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3405
Practice Address - Country:US
Practice Address - Phone:410-309-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33802207Q00000X
MDD0064035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine