Provider Demographics
NPI:1710444021
Name:DR. GEORGE SHEPEARD PA
Entity Type:Organization
Organization Name:DR. GEORGE SHEPEARD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPEARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-815-7657
Mailing Address - Street 1:3063 PERRIWINKLE CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6702
Mailing Address - Country:US
Mailing Address - Phone:954-815-7657
Mailing Address - Fax:
Practice Address - Street 1:3063 PERRIWINKLE CIR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-6702
Practice Address - Country:US
Practice Address - Phone:800-555-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty