Provider Demographics
NPI:1982351490
Name:SHEPPARD, MARTIN FENDER
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:FENDER
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3871 SWEETEN CREEK RD STE B
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-3175
Mailing Address - Country:US
Mailing Address - Phone:828-767-0252
Mailing Address - Fax:
Practice Address - Street 1:3871 SWEETEN CREEK RD STE B
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-3175
Practice Address - Country:US
Practice Address - Phone:828-767-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3721048OtherNC ID