Healthcare Provider Details

I. General information

NPI: 1811806581
Provider Name (Legal Business Name): SCOTT A SHEPHERD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

149 TIMBERHILL DR APT 2B
HAMILTON OH
45013-3973
US

IV. Provider business mailing address

149 TIMBERHILL DR
HAMILTON OH
45013-5604
US

V. Phone/Fax

Practice location:
  • Phone: 513-904-3533
  • Fax:
Mailing address:
  • Phone: 513-904-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.007256
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: