Healthcare Provider Details

I. General information

NPI: 1922068485
Provider Name (Legal Business Name): LINDSAY T SHEPARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY T MCINTYRE PA-C

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 MILFORD ST
UPTON MA
01568
US

IV. Provider business mailing address

298 ARMISTICE BLVD
PAWTUCKET RI
02861-2331
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-1015
  • Fax: 508-634-0261
Mailing address:
  • Phone: 508-473-1015
  • Fax: 508-634-0261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1979
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: