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General NPI Number Information
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NPI Number | 1700338381
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Entity Type | Individual
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Provider Name | SUZANNE SHEPARD PT, DPT, PCS
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Gender | Female
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 40 HENRIETTA BLVD
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City | AMSTERDAM
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State | NY
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Zip | 12010-1111
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Country | US
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Telephone | 518-265-2462
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Fax |
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Provider Business Mailing Address
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Address Line | 2841 THOUSAND ACRES RD
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City | DELANSON
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State | NY
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Zip | 12053-1917
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Country | US
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Telephone |
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 040277
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 040277
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License Number State | NY
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