Healthcare Provider Details

I. General information

NPI: 1669978789
Provider Name (Legal Business Name): SYDNEY M SHEPHERD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4627 NW 53RD AVE
GAINESVILLE FL
32653-4857
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 352-335-8888
  • Fax:
Mailing address:
  • Phone: 614-315-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME155194
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: