Provider Demographics
NPI:1700631298
Name:SHEPPARD, RODNEY SR (PRSS)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:
Last Name:SHEPPARD
Suffix:SR
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 W MOHAVE ST APT 810
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-2742
Mailing Address - Country:US
Mailing Address - Phone:626-831-0313
Mailing Address - Fax:
Practice Address - Street 1:142 W MOHAVE ST STE 810
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2742
Practice Address - Country:US
Practice Address - Phone:626-831-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist