Provider Demographics
NPI:1740393750
Name:SHEPARD, JANET M (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LONG POND RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2642
Mailing Address - Country:US
Mailing Address - Phone:508-746-7272
Mailing Address - Fax:508-746-0104
Practice Address - Street 1:110 LONG POND RD
Practice Address - Street 2:SUITE 212
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2642
Practice Address - Country:US
Practice Address - Phone:508-746-7272
Practice Address - Fax:508-746-0104
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182208363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
R85254Medicare UPIN
NP0562Medicare ID - Type Unspecified