MEDICARE: DR. SARI SHEPPHIRD PH.D.

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	103T00000X	Psychologist	PSY20922	CA
2	103TC0700X	Clinical Psychologist	PSY20922	CA

General Provider Information

NPI Number	:	1881777951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARI SHEPPHIRD PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 66075
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-0075
Country	:	US
Telephone Number	:	310-826-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 OVERLAND AVE
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3346
Country	:	US
Telephone Number	:	310-826-4300
Fax Number	:	310-558-0799

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	11/06/2008

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