Provider Demographics
NPI:1790512135
Name:SHEPHERD, CYNTHIA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3237
Mailing Address - Country:US
Mailing Address - Phone:304-752-1316
Mailing Address - Fax:
Practice Address - Street 1:1012 1ST AVE
Practice Address - Street 2:
Practice Address - City:WEST LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3237
Practice Address - Country:US
Practice Address - Phone:304-752-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide