Healthcare Provider Details

I. General information

NPI: 1619871795
Provider Name (Legal Business Name): CORYN SHEPHERD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DISCOVERY PL
SILVER SPRING MD
20910-3354
US

IV. Provider business mailing address

11002 ASCOTT VIEW LN
SILVER SPRING MD
20901-4570
US

V. Phone/Fax

Practice location:
  • Phone: 240-438-4934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: