Provider Demographics
NPI:1023086469
Name:CELESTE SHEPPARD, M.D., P.A.
Entity type:Organization
Organization Name:CELESTE SHEPPARD, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-339-1010
Mailing Address - Street 1:4100 DUVAL RD
Mailing Address - Street 2:BUILDING II, SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3550
Mailing Address - Country:US
Mailing Address - Phone:512-339-1010
Mailing Address - Fax:512-339-1011
Practice Address - Street 1:4100 DUVAL RD
Practice Address - Street 2:BUILDING II, SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3550
Practice Address - Country:US
Practice Address - Phone:512-339-1010
Practice Address - Fax:512-339-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8396207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF60406Medicare UPIN
TX00535XMedicare ID - Type UnspecifiedGROUP #
TX8C7316Medicare ID - Type UnspecifiedDR. SHEPPARD'S IND #