Provider Demographics
NPI:1790770733
Name:SHEPARD, ASHLEY KIRSTEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:KIRSTEN
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:KIRSTEN
Other - Last Name:REEVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 409
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-547-0616
Mailing Address - Fax:860-524-2655
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE 409
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-547-0616
Practice Address - Fax:860-524-2655
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000777213E00000X, 213ES0103X, 213ER0200X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V3380OtherHEALTH NET
MA0322890Medicaid
CT077700OtherCTCARE
CT030000777CT01OtherANTHEM BCBS
CT1176045 002OtherCIGNA
CT3225079OtherAETNA
CTP2883933OtherOXFORD
CT2V3380OtherHEALTH NET