MEDICARE: SHEREE SHEPHARD

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	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	378210580599	OTHER	OH	STNA/HHA

General Provider Information

NPI Number	:	1073112801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEREE SHEPHARD

Provider Business Mailing Address
First Line	:	13813 BANGOR AVE
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-6006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13813 BANGOR AVE
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-6006
Country	:	US
Telephone Number	:	216-217-2470
Fax Number	:

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

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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Directions to “ SHEREE SHEPHARD ” Practice Location

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