Healthcare Provider Details

I. General information

NPI: 1043205628
Provider Name (Legal Business Name): DEBORAH APOLLO SHEPARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BUNTINGS MILL CT
SELBYVILLE DE
19975-3627
US

IV. Provider business mailing address

64 BUNTINGS MILL CT
SELBYVILLE DE
19975-3627
US

V. Phone/Fax

Practice location:
  • Phone: 952-807-7162
  • Fax:
Mailing address:
  • Phone: 952-807-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number06263
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0001083
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: