Provider Demographics
NPI:1922624261
Name:SHEPARD, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 WALNUT CIR APT A7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6628
Mailing Address - Country:US
Mailing Address - Phone:419-377-7563
Mailing Address - Fax:
Practice Address - Street 1:5916 WALNUT CIR APT A7
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6628
Practice Address - Country:US
Practice Address - Phone:419-377-7563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4009496207093747A0650X, 3747P1801X
OH374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374J00000XNursing Service Related ProvidersDoula