MEDICARE: CYNTHIA 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	363L00000X	Nurse Practitioner	71007311A	IN

General Provider Information

NPI Number	:	1912435058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA SHEPHERD

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5419 COUNTY ROAD 427
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-9504
Country	:	US
Telephone Number	:	260-333-5105
Fax Number	:

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

Provider Enumeration Date	:	06/02/2017
Last Update Date	:	07/19/2023

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Directions to “ CYNTHIA SHEPHERD ” Practice Location

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