Provider Demographics
NPI:1912469222
Name:SHEPPARD, YURIKO (LMT)
Entity Type:Individual
Prefix:
First Name:YURIKO
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PROFESSIONAL PKWY STE 1503
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4334
Mailing Address - Country:US
Mailing Address - Phone:757-744-4325
Mailing Address - Fax:
Practice Address - Street 1:105 PROFESSIONAL PKWY STE 1503
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4334
Practice Address - Country:US
Practice Address - Phone:757-744-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist