Provider Demographics
NPI:1851932677
Name:SHEPHERD, TERI LYNN (MA ED)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:LYNN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MA ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 MACARTHUR BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3847
Mailing Address - Country:US
Mailing Address - Phone:415-825-2273
Mailing Address - Fax:
Practice Address - Street 1:916 MACARTHUR BLVD APT 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3847
Practice Address - Country:US
Practice Address - Phone:415-825-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator