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NPI Code Detail

MEDICARE: JEANNINE ELIZABETH SHEPPARD D.O.

MEDICARE: JEANNINE ELIZABETH SHEPPARD D.O.
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
12084P0800XPsychiatry Physician34 007365OH

General Provider Information

NPI Number : 1720105109
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNINE ELIZABETH SHEPPARD D.O.
Provider Business Mailing Address
First Line : 7621 E VON DETTE CIR
Second Line :
City : CENTERVILLE FINANCE
State : OH
Zip : 45459-5037
Country : US
Telephone Number : 937-648-7274
Fax Number :
Provider Business Practice Location Address
First Line : 600 WAYNE AVE
Second Line :
City : DAYTON
State : OH
Zip : 45410-1122
Country : US
Telephone Number : 937-496-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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