Provider Demographics
NPI:1588191183
Name:SANFORD, WALTER SHEPPARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:SHEPPARD
Last Name:SANFORD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2318
Mailing Address - Country:US
Mailing Address - Phone:502-585-1911
Mailing Address - Fax:
Practice Address - Street 1:501 PARK AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2318
Practice Address - Country:US
Practice Address - Phone:502-585-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129535103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical