MEDICARE: TIFFANY RAE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.188896	OH
2	175T00000X	Peer Specialist	APS.005354	OH
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1811725542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY RAE SHEPHERD

Provider Business Mailing Address
First Line	:	1237 E 172ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-3128
Country	:	US
Telephone Number	:	216-334-4627
Fax Number	:

Provider Business Practice Location Address
First Line	:	1237 E 172ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-3128
Country	:	US
Telephone Number	:	216-334-4627
Fax Number	:

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

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	08/27/2025

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Directions to “ TIFFANY RAE SHEPHERD ” Practice Location

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