Provider Demographics
NPI:1609480706
Name:SHEPPARD, SANDRA KATHLENE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KATHLENE
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:WV
Mailing Address - Zip Code:25685-0001
Mailing Address - Country:US
Mailing Address - Phone:304-475-2264
Mailing Address - Fax:
Practice Address - Street 1:148 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:DELBARTON
Practice Address - State:WV
Practice Address - Zip Code:25670-9690
Practice Address - Country:US
Practice Address - Phone:304-475-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant