Provider Demographics
NPI:1720603426
Name:SHEPARD, OB LA'ANTHONY
Entity Type:Individual
Prefix:MR
First Name:OB
Middle Name:LA'ANTHONY
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 COURTSIDE DR APT D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-8208
Mailing Address - Country:US
Mailing Address - Phone:614-986-7280
Mailing Address - Fax:
Practice Address - Street 1:2207 COURTSIDE DR APT D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-8208
Practice Address - Country:US
Practice Address - Phone:614-986-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide