MEDICARE: ANTHONY TRAYVON SHEPARD

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	163WD0400X	Diabetes Educator Registered Nurse	0806091399	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336845908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY TRAYVON SHEPARD

Provider Business Mailing Address
First Line	:	6060 SILVER LAKE RD APT 13G
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89506-1782
Country	:	US
Telephone Number	:	775-303-6446
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 SILVER LAKE RD APT 13G
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89506-1782
Country	:	US
Telephone Number	:	775-303-6446
Fax Number	:

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

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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Directions to “ ANTHONY TRAYVON SHEPARD ” Practice Location

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