MEDICARE: CURLISA C 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1659060903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURLISA C SHEPPARD

Provider Business Mailing Address
First Line	:	800 BROWARD RD APT J104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-5928
Country	:	US
Telephone Number	:	904-753-7187
Fax Number	:

Provider Business Practice Location Address
First Line	:	5843 JOHN F KENNEDY DR N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3509
Country	:	US
Telephone Number	:	894-753-7187
Fax Number	:

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

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	05/03/2023

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Directions to “ CURLISA C SHEPPARD ” Practice Location

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