Provider Demographics
NPI:1841397361
Name:SHEPHERD, AILEEN M (DOM)
Entity Type:Individual
Prefix:MRS
First Name:AILEEN
Middle Name:M
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:TAMAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:MAGDALENA
Mailing Address - State:NM
Mailing Address - Zip Code:87825-1132
Mailing Address - Country:US
Mailing Address - Phone:505-418-2156
Mailing Address - Fax:505-838-0394
Practice Address - Street 1:832 W HWY 60
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801
Practice Address - Country:US
Practice Address - Phone:505-838-1100
Practice Address - Fax:505-838-0394
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM619171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist