Provider Demographics
NPI:1952422941
Name:SHEPPARD, SHIRL DENISE (MEDWAVIER PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:SHIRL
Middle Name:DENISE
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:MEDWAVIER PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 PAR AVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-671-9060
Mailing Address - Fax:386-615-8376
Practice Address - Street 1:1321 PAR AVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-671-9060
Practice Address - Fax:386-615-8376
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide