Healthcare Provider Details

I. General information

NPI: 1679375315
Provider Name (Legal Business Name): JUSTIN JEROME SHEPPARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WESTSIDE HOSPITAL 8201 WEST BROWARD BLVD PLANTATION, FL
PLANTATION FL
33324
US

IV. Provider business mailing address

WESTSIDE HOSPITAL 8201 WEST BROWARD BLVD PLANTATION, FL ARNIECE GUTIERREZ
PLANTATION FL
33324
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: