Healthcare Provider Details

I. General information

NPI: 1306225255
Provider Name (Legal Business Name): DANIELLE SHEPPARD N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 COOPER FOSTER PARK RD W
LORAIN OH
44053-4152
US

IV. Provider business mailing address

160 WOODHILL DR
AMHERST OH
44001-1614
US

V. Phone/Fax

Practice location:
  • Phone: 440-204-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN. 34448-1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA. 17172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: