Healthcare Provider Details

I. General information

NPI: 1447232483
Provider Name (Legal Business Name): ELIZABETH A KENNEDY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. ELIZABETH A SHEPHERD

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CLEMENTS BRIDGE ROAD
BARRINGTON NJ
08007
US

IV. Provider business mailing address

121 CLEMENTS BRIDGE ROAD
BARRINGTON NJ
08007
US

V. Phone/Fax

Practice location:
  • Phone: 856-546-1535
  • Fax: 856-546-6565
Mailing address:
  • Phone: 856-546-1535
  • Fax: 856-546-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00009600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number25MG0004800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: