Provider Demographics
NPI:1942998216
Name:SHEPHERD, JOAN BERNICE
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:BERNICE
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 1:13 HARVEST HILL RD PH
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-3524
Mailing Address - Country:US
Mailing Address - Phone:917-861-8002
Mailing Address - Fax:
Practice Address - Street 1:50 OVERLIN RD
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-8950
Practice Address - Country:US
Practice Address - Phone:914-483-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY417130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse