Healthcare Provider Details

I. General information

NPI: 1669508834
Provider Name (Legal Business Name): LAKEISHA SHERILLE SHEPHERD APRN- FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 SUNNYACRES RD
COPLEY OH
44321-2331
US

IV. Provider business mailing address

1616 SUNNYACRES RD
COPLEY OH
44321-2331
US

V. Phone/Fax

Practice location:
  • Phone: 330-242-0938
  • Fax:
Mailing address:
  • Phone: 330-591-8730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number020629
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number084573-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number318338
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: