Provider Demographics
NPI:1740916295
Name:SHEPHERD, RACHEL (NP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:LAPORTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5851 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5799
Mailing Address - Country:US
Mailing Address - Phone:716-932-6080
Mailing Address - Fax:716-332-4245
Practice Address - Street 1:5851 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5799
Practice Address - Country:US
Practice Address - Phone:716-932-6080
Practice Address - Fax:716-332-4245
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688536163WG0000X
NY310802363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice