Healthcare Provider Details

I. General information

NPI: 1982305884
Provider Name (Legal Business Name): CINDY MARIE SHEPPARD SA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

6703 WILBER CIR
HENRICO VA
23228-4865
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-8203
  • Fax: 804-287-7710
Mailing address:
  • Phone: 804-678-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000121
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: