MEDICARE: DAVID 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	103TC0700X	Clinical Psychologist	PSY32258	CA

General Provider Information

NPI Number	:	1770779795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SHEPARD

Provider Business Mailing Address
First Line	:	414 E 15TH ST APT 7
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-2340
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	582 MARKET ST STE 1203
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-5313
Country	:	US
Telephone Number	:	415-343-5890
Fax Number	:

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	01/23/2024

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Directions to “ DAVID SHEPARD ” Practice Location

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