Provider Demographics
NPI:1205168903
Name:SHEPHERD, CECILIA AUGUSTA (CSA/CST)
Entity type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:AUGUSTA
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:CSA/CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3714
Mailing Address - Street 2:
Mailing Address - City:WEST SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42564-3714
Mailing Address - Country:US
Mailing Address - Phone:606-224-2566
Mailing Address - Fax:
Practice Address - Street 1:420 STILESVILLE RD
Practice Address - Street 2:
Practice Address - City:SCIENCE HILL
Practice Address - State:KY
Practice Address - Zip Code:42553-7410
Practice Address - Country:US
Practice Address - Phone:606-219-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3429246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist