Provider Demographics
NPI:1568848877
Name:SHEPPARD, ROSALINDA
Entity Type:Individual
Prefix:
First Name:ROSALINDA
Middle Name:
Last Name:SHEPPARD
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 1:10406 INDIANA AVE APT 159
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5398
Mailing Address - Country:US
Mailing Address - Phone:909-438-4212
Mailing Address - Fax:
Practice Address - Street 1:10406 INDIANA AVE APT 159
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5398
Practice Address - Country:US
Practice Address - Phone:909-438-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health