Healthcare Provider Details

I. General information

NPI: 1568411262
Provider Name (Legal Business Name): KENNETH B SHEPHARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 CORAL WAY STE 309
MIAMI FL
33145-3214
US

IV. Provider business mailing address

8700 N KENDALL DR STE 102
MIAMI FL
33176-2206
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-1919
  • Fax: 305-273-1929
Mailing address:
  • Phone: 305-273-1919
  • Fax: 305-272-1929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME61784
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: