Healthcare Provider Details

I. General information

NPI: 1467759613
Provider Name (Legal Business Name): KERISHA KAY-DEAN SHEPARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 OLD RIDGEBURY RD
DANBURY CT
06810-5128
US

IV. Provider business mailing address

38 OLD RIDGEBURY RD
DANBURY CT
06810-5128
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-4515
  • Fax:
Mailing address:
  • Phone: 203-792-4515
  • Fax: 914-773-7833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10155
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number637747
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: