Provider Demographics
NPI:1922068485
Name:SHEPARD, LINDSAY T (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:T
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:T
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:298 ARMISTICE BLVD
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-2331
Mailing Address - Country:US
Mailing Address - Phone:508-473-1015
Mailing Address - Fax:508-634-0261
Practice Address - Street 1:236 MILFORD ST
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568
Practice Address - Country:US
Practice Address - Phone:508-473-1015
Practice Address - Fax:508-634-0261
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1979363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
99546OtherFALLON COMMUNITY HEALTH P
MAQ62003Medicare UPIN
MAAP2578Medicare ID - Type UnspecifiedMEDICARE NUMBER