Healthcare Provider Details

I. General information

NPI: 1962808212
Provider Name (Legal Business Name): VIVIAN CHANG SHEPARD M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SCHUYLER RD
SILVER SPRING MD
20910-4272
US

IV. Provider business mailing address

500 SCHUYLER RD
SILVER SPRING MD
20910-4272
US

V. Phone/Fax

Practice location:
  • Phone: 240-740-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number708784
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: