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NPI Code Detail

MEDICARE: BRYAN WILLIAM MARCUS SHEPPARD

MEDICARE: BRYAN WILLIAM MARCUS SHEPPARD
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1255204392
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN WILLIAM MARCUS SHEPPARD
Provider Business Mailing Address
First Line : PO BOX 740780
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0780
Country : US
Telephone Number : 855-223-7123
Fax Number :
Provider Business Practice Location Address
First Line : 9129 ELK GROVE BLVD
Second Line :
City : ELK GROVE
State : CA
Zip : 95624-2012
Country : US
Telephone Number : 855-223-7123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2025
Last Update Date : 05/11/2026

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Directions to “ BRYAN WILLIAM MARCUS SHEPPARD ” Practice Location

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