Provider Demographics
NPI:1558502856
Name:SHEPARD, CAROL (SPECIAL EDUCATION)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1923
Mailing Address - Country:US
Mailing Address - Phone:516-692-9713
Mailing Address - Fax:
Practice Address - Street 1:84 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1923
Practice Address - Country:US
Practice Address - Phone:516-692-9713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMS SPECIAL EDUCATOR171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor