Provider Demographics
NPI:1770268716
Name:SHEPARD, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
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 1:9 NEW CANAAN WAY
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-1443
Mailing Address - Country:US
Mailing Address - Phone:203-451-6463
Mailing Address - Fax:
Practice Address - Street 1:9 NEW CANAAN WAY
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-1443
Practice Address - Country:US
Practice Address - Phone:203-451-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered