Provider Demographics
NPI:1558105791
Name:SHEPARD, SYDNEY JAYMES (DMD)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:JAYMES
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 INDIAN BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-4447
Mailing Address - Country:US
Mailing Address - Phone:850-797-2902
Mailing Address - Fax:
Practice Address - Street 1:4635 GULFSTARR DR STE 200
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-0742
Practice Address - Country:US
Practice Address - Phone:850-797-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN291401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice