MEDICARE: DEMETRIA LALITA SHEARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	P-2243	NE

General Provider Information

NPI Number	:	1043018625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRIA LALITA SHEARD

Provider Business Mailing Address
First Line	:	319 S 17TH ST STE 233
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68102-2040
Country	:	US
Telephone Number	:	402-403-1367
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 S 17TH ST STE 233
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68102-2040
Country	:	US
Telephone Number	:	402-403-1367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/07/2025

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Directions to “ DEMETRIA LALITA SHEARD ” Practice Location

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