Provider Demographics
NPI:1881783280
Name:SHEPARDSON, ALETHEA K (RNP)
Entity type:Individual
Prefix:
First Name:ALETHEA
Middle Name:K
Last Name:SHEPARDSON
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 94TH ST
Mailing Address - Street 2:APT. 14J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6954
Mailing Address - Country:US
Mailing Address - Phone:718-920-5544
Mailing Address - Fax:718-920-5202
Practice Address - Street 1:CLINICAL DIABETES CENTER
Practice Address - Street 2:3411 WAYNE AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-920-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner