Healthcare Provider Details

I. General information

NPI: 1780202051
Provider Name (Legal Business Name): DAMON WYATT SHEPHERD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7023 AMBROSIA LN APT 1003
NAPLES FL
34119-9648
US

IV. Provider business mailing address

7023 AMBROSIA LN APT 1003
NAPLES FL
34119-9648
US

V. Phone/Fax

Practice location:
  • Phone: 336-287-1706
  • Fax:
Mailing address:
  • Phone: 336-287-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: