Provider Demographics
NPI:1619139805
Name:SHEPARD, DAMIRAE R (RN)
Entity Type:Individual
Prefix:MRS
First Name:DAMIRAE
Middle Name:R
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:DAMIRAE
Other - Middle Name:R
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3788 COUNTY ROUTE 36
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-9426
Mailing Address - Country:US
Mailing Address - Phone:607-281-7153
Mailing Address - Fax:
Practice Address - Street 1:3788 COUNTY ROUTE 36
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-9426
Practice Address - Country:US
Practice Address - Phone:585-534-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10236090164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse