Healthcare Provider Details

I. General information

NPI: 1578525937
Provider Name (Legal Business Name): ROBERT CHARLES SHEPPARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 02/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 49TH ST N STE. 200
ST PETERSBURG FL
33709-2148
US

IV. Provider business mailing address

6006 49TH ST N STE. 200
ST PETERSBURG FL
33709-2148
US

V. Phone/Fax

Practice location:
  • Phone: 727-490-2100
  • Fax: 727-544-7389
Mailing address:
  • Phone: 727-490-2100
  • Fax: 727-544-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME65461
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME65461
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: