Healthcare Provider Details

I. General information

NPI: 1437581352
Provider Name (Legal Business Name): ANDREA SHEPPARD-BRICK RN, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

88 ELM STREET EXT
NEW MILFORD CT
06776-3032
US

V. Phone/Fax

Practice location:
  • Phone: 413-449-3598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338146-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5504
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: