Provider Demographics
NPI:1922268440
Name:SHEPHERD, HAZEL-WOOD SHELAYA (LPN)
Entity Type:Individual
Prefix:
First Name:HAZEL-WOOD
Middle Name:SHELAYA
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SARAH COURT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4760
Mailing Address - Country:US
Mailing Address - Phone:732-833-8140
Mailing Address - Fax:
Practice Address - Street 1:6 SARAH CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4760
Practice Address - Country:US
Practice Address - Phone:732-833-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272298-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse