Provider Demographics
NPI:1851726335
Name:SHEPHERD, STEPHANIE KING (MA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KING
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W SOUTH 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-3324
Mailing Address - Country:US
Mailing Address - Phone:864-886-4455
Mailing Address - Fax:
Practice Address - Street 1:810 W SOUTH 4TH ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3324
Practice Address - Country:US
Practice Address - Phone:864-886-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist