Provider Demographics
NPI:1518356823
Name:SHEWARD, DEBORA
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:
Last Name:SHEWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 BLUE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:STOUT
Mailing Address - State:OH
Mailing Address - Zip Code:45684-9623
Mailing Address - Country:US
Mailing Address - Phone:740-464-2309
Mailing Address - Fax:
Practice Address - Street 1:2155 BLUE CREEK RD
Practice Address - Street 2:
Practice Address - City:STOUT
Practice Address - State:OH
Practice Address - Zip Code:45684-9623
Practice Address - Country:US
Practice Address - Phone:740-464-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400522090806172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker