MEDICARE: MICHELLE SHEPARD MS

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	235Z00000X	Speech-Language Pathologist	704348131	NY

General Provider Information

NPI Number	:	1538400395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SHEPARD MS

Provider Business Mailing Address
First Line	:	360 W 22ND ST
Second Line	:	APT. 8M
City	:	NEW YORK
State	:	NY
Zip	:	10011-2600
Country	:	US
Telephone Number	:	917-647-4608
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 KENT AVE
Second Line	:	SUITE 101
City	:	BROOKLYN
State	:	NY
Zip	:	11205-1581
Country	:	US
Telephone Number	:	718-473-3808
Fax Number	:

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

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	03/04/2013

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Directions to “ MICHELLE SHEPARD MS” Practice Location

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