Healthcare Provider Details

I. General information

NPI: 1053997437
Provider Name (Legal Business Name): SYDNEY JULIA BIAN SHEPARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 CROSS BRONX EXPY
BRONX NY
10460-4885
US

IV. Provider business mailing address

2819 TILDEN AVE APT 2B
BROOKLYN NY
11226-5050
US

V. Phone/Fax

Practice location:
  • Phone: 718-665-7565
  • Fax:
Mailing address:
  • Phone: 718-483-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number097050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: