Provider Demographics
NPI:1356553184
Name:SHEPHERD, SCOTT C
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:C
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 OLD TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:MUNSONVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03457-5135
Mailing Address - Country:US
Mailing Address - Phone:603-847-9974
Mailing Address - Fax:
Practice Address - Street 1:17 93RD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3748
Practice Address - Country:US
Practice Address - Phone:603-924-7236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator