Provider Demographics
NPI:1992274252
Name:SHEPHERD, KAYON (HAIR REPLACEMENT TE)
Entity type:Individual
Prefix:MS
First Name:KAYON
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT TE
Other - Prefix:
Other - First Name:KAYON
Other - Middle Name:
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KAYON SHEPHERD
Mailing Address - Street 1:6250 CYPRESS GARDENS BLVD STE 27
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3177
Mailing Address - Country:US
Mailing Address - Phone:954-951-4310
Mailing Address - Fax:
Practice Address - Street 1:6250 CYPRESS GARDENS BLVD STE 27
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3177
Practice Address - Country:US
Practice Address - Phone:954-951-4310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 224P00000X, 335E00000X
FL224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No174400000XOther Service ProvidersSpecialist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47-2338905Other