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General NPI Number Information
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NPI Number | 1356601389
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Entity Type | Individual
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Provider Name | REGINA B SHEPHERD MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 1680 GEORGETOWNE BLVD
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City | SARASOTA
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State | FL
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Zip | 34232-2008
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Country | US
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Telephone | 941-378-4662
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Fax | 941-343-9402
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Provider Business Mailing Address
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Address Line | 1680 GEORGETOWNE BLVD
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City | SARASOTA
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State | FL
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Zip | 34232-2008
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Country | US
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Telephone | 941-378-4662
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Fax | 941-343-9402
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA1161
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License Number State | FL
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