Provider Demographics
NPI:1295737013
Name:SHEPARD, CYNTHIA A (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 ANNS CHOICE WAY
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-3527
Mailing Address - Country:US
Mailing Address - Phone:215-443-3850
Mailing Address - Fax:215-443-3963
Practice Address - Street 1:10000 ANNS CHOICE WAY
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3527
Practice Address - Country:US
Practice Address - Phone:215-443-3850
Practice Address - Fax:215-443-3963
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA061491-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
27-07975OtherEVERCARE
SH1872656OtherHIGHMARK BS
2732282000OtherINDEPENDENCE BC-KEYSTONE
611455212OtherTRICARE NORTH
27-07975OtherEVERCARE
073385Medicare PIN
D18921Medicare UPIN