Provider Demographics
NPI:1679815633
Name:SHEPEARD, GEORGE ROY III (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ROY
Last Name:SHEPEARD
Suffix:III
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 1:2741 EXECUTIVE PARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3641
Mailing Address - Country:US
Mailing Address - Phone:954-385-6750
Mailing Address - Fax:
Practice Address - Street 1:2741 EXECUTIVE PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3641
Practice Address - Country:US
Practice Address - Phone:954-385-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-5830103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist