Healthcare Provider Details

I. General information

NPI: 1659293348
Provider Name (Legal Business Name): MICHAEL BRANDON SHEPPARD ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LAKESHORE DR
BIRMINGHAM AL
35229-0002
US

IV. Provider business mailing address

2606 CAHABA RIVER EST
HOOVER AL
35244-4422
US

V. Phone/Fax

Practice location:
  • Phone: 205-337-9401
  • Fax:
Mailing address:
  • Phone: 205-337-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2367
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: