MEDICARE: EMILCE 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
1	225200000X	Physical Therapy Assistant	2306602085	VA
2	171100000X	Acupuncturist	0121000800	VA

General Provider Information

NPI Number	:	1346659463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILCE SHEPPARD

Provider Business Mailing Address
First Line	:	3737 W MAIN ST STE 101
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-2073
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 W MAIN ST STE 101
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-2073
Country	:	US
Telephone Number	:	540-444-3668
Fax Number	:

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

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	03/25/2019

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Directions to “ EMILCE SHEPPARD ” Practice Location

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