MEDICARE: DAMON WYATT SHEPHERD

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	237700000X	Hearing Instrument Specialist	AS5923	FL

General Provider Information

NPI Number	:	1780202051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMON WYATT SHEPHERD

Provider Business Mailing Address
First Line	:	7023 AMBROSIA LN APT 1003
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-9648
Country	:	US
Telephone Number	:	336-287-1706
Fax Number	:

Provider Business Practice Location Address
First Line	:	7023 AMBROSIA LN APT 1003
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-9648
Country	:	US
Telephone Number	:	336-287-1706
Fax Number	:

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

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	05/05/2026

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