Provider Demographics
NPI:1922714856
Name:SHEPHERD, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:SHEPHERD
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 1:14425 33RD AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3104
Mailing Address - Country:US
Mailing Address - Phone:917-640-5762
Mailing Address - Fax:
Practice Address - Street 1:14425 33RD AVE APT 2L
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3104
Practice Address - Country:US
Practice Address - Phone:917-640-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker