Provider Demographics
NPI:1841936861
Name:BRANDI R SHEPARD LLC
Entity type:Organization
Organization Name:BRANDI R SHEPARD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-578-2976
Mailing Address - Street 1:902 BLACKBURN ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8494
Mailing Address - Country:US
Mailing Address - Phone:307-578-2976
Mailing Address - Fax:307-578-2941
Practice Address - Street 1:902 BLACKBURN ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8494
Practice Address - Country:US
Practice Address - Phone:307-587-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANDI SHEPARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-11
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty