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General NPI Number Information
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NPI Number | 1710444021
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Entity Type | Organization
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Legal Business Name | DR. GEORGE SHEPEARD PA
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 3063 PERRIWINKLE CIR
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City | DAVIE
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State | FL
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Zip | 33328-6702
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Country | US
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Telephone | 800-555-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 3063 PERRIWINKLE CIR
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City | DAVIE
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State | FL
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Zip | 33328-6702
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Country | US
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Telephone | 954-815-7657
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. GEORGE SHEPEARD
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Credential | PSY.D.
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Telephone | 954-815-7657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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