Provider Demographics
NPI:1982316147
Name:SHEPARD, SIERA A (RBT)
Entity Type:Individual
Prefix:MS
First Name:SIERA
Middle Name:A
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 CHESLIE ARCH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-6722
Mailing Address - Country:US
Mailing Address - Phone:251-348-1402
Mailing Address - Fax:
Practice Address - Street 1:4016 RAINTREE RD STE 220B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3790
Practice Address - Country:US
Practice Address - Phone:757-465-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-22-248147106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician