Healthcare Provider Details

I. General information

NPI: 1235109612
Provider Name (Legal Business Name): VICTORIA L SHEPPARD-LABRECQUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 E CACTUS RD STE 940
SCOTTSDALE AZ
85254-4164
US

IV. Provider business mailing address

4848 E CACTUS RD STE 940
SCOTTSDALE AZ
85254-4164
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-0050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number56454
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: