Provider Demographics
NPI:1134956147
Name:SHEPARD, SHA'QUELA D (CNA)
Entity type:Individual
Prefix:MS
First Name:SHA'QUELA
Middle Name:D
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 CORDOVA AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1808
Mailing Address - Country:US
Mailing Address - Phone:330-330-7448
Mailing Address - Fax:
Practice Address - Street 1:1870 CORDOVA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1808
Practice Address - Country:US
Practice Address - Phone:330-330-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400917350509376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide