Provider Demographics
NPI:1578857447
Name:SHEPPARD, STEPHANIE ROSENBLOOM (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROSENBLOOM
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RESERVOIR RD NW
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-5437
Mailing Address - Fax:202-444-2961
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-5437
Practice Address - Fax:202-444-2961
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00777182080N0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program