MEDICARE: MRS. DEBORAH APOLLO SHEPARD FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	06263	OH
2	363LF0000X	Family Nurse Practitioner	LG0001083	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	613154600	OTHER	WV	BLACK LUNG/FECA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1043205628	OTHER	WV	MTN ST BCBS

General Provider Information

NPI Number	:	1043205628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH APOLLO SHEPARD FNP-C

Provider Business Mailing Address
First Line	:	64 BUNTINGS MILL CT
Second Line	:
City	:	SELBYVILLE
State	:	DE
Zip	:	19975-3627
Country	:	US
Telephone Number	:	952-807-7162
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 BUNTINGS MILL CT
Second Line	:
City	:	SELBYVILLE
State	:	DE
Zip	:	19975-3627
Country	:	US
Telephone Number	:	952-807-7162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	05/02/2025

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