Healthcare Provider Details

I. General information

NPI: 1750720611
Provider Name (Legal Business Name): SARAH THERESE SHEPARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 SHIPYARD BLVD
WILMINGTON NC
28403-8052
US

IV. Provider business mailing address

PO BOX 604136
CHARLOTTE NC
28260-4136
US

V. Phone/Fax

Practice location:
  • Phone: 910-662-9480
  • Fax: 910-332-5666
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2018-01009
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2018-01009
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number0057096
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0004929
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: