Provider Demographics
NPI:1649061110
Name:SHEPARD, STEPHANIE RENEE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11630 TOWNE AVE # B1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-2956
Mailing Address - Country:US
Mailing Address - Phone:424-200-8246
Mailing Address - Fax:
Practice Address - Street 1:11630 TOWNE AVE
Practice Address - Street 2:B1
Practice Address - City:LOS ANGELES CALIFORNIA
Practice Address - State:CA
Practice Address - Zip Code:90061
Practice Address - Country:US
Practice Address - Phone:310-925-4832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider