Provider Demographics
NPI:1619918711
Name:SHEPARD, DEBRA G (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:G
Last Name:SHEPARD
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 1:1008 GOODLETTE RD N
Mailing Address - Street 2:STE 100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5406
Mailing Address - Country:US
Mailing Address - Phone:239-262-8226
Mailing Address - Fax:
Practice Address - Street 1:1008 GOODLETTE RD N
Practice Address - Street 2:STE 100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5406
Practice Address - Country:US
Practice Address - Phone:239-262-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0187815OtherUNITED HEALTH
FL254504700Medicaid
FL254504700Medicaid