Provider Demographics
NPI:1811365513
Name:SARAH D. SHEPHERD, D.O.LLC
Entity Type:Organization
Organization Name:SARAH D. SHEPHERD, D.O.LLC
Other - Org Name:OSTEOPATHIC HEALING HANDS OF MAINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-502-7281
Mailing Address - Street 1:83 PORTLAND ROAD SUITE #2
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043
Mailing Address - Country:US
Mailing Address - Phone:207-502-7281
Mailing Address - Fax:207-502-7327
Practice Address - Street 1:27 WADLIN ROAD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005
Practice Address - Country:US
Practice Address - Phone:970-201-7887
Practice Address - Fax:207-502-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2307261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME00278250Medicare Oscar/Certification