Provider Demographics
NPI:1669183695
Name:SHEPHARD, SCOEY LEWIS
Entity type:Individual
Prefix:
First Name:SCOEY
Middle Name:LEWIS
Last Name:SHEPHARD
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 1:15716 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-7051
Mailing Address - Country:US
Mailing Address - Phone:561-715-9163
Mailing Address - Fax:
Practice Address - Street 1:15716 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-7051
Practice Address - Country:US
Practice Address - Phone:561-715-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9451735163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse