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General NPI Number Information
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NPI Number | 1285023309
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE PEDIATRICS OF NAPLES, LLC
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 3227 HORSESHOE DR S
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City | NAPLES
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State | FL
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Zip | 34104-6114
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Country | US
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Telephone | 239-449-9882
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Fax | 239-449-9884
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Provider Business Mailing Address
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Address Line | 3227 HORSESHOE DR S
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City | NAPLES
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State | FL
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Zip | 34104-6114
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Country | US
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Telephone | 239-449-9882
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Fax | 239-449-9884
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Authorized Official
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Title or Position | DOCTOR/PRACTICE CO-OWNER
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Name | DR. DEBRA GOODRIDGE SHEPARD
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Credential | M.D.
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Telephone | 239-449-9882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | ME0053566
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME076050
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License Number State | FL
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