MEDICARE: KELLY M 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	235Z00000X	Speech-Language Pathologist	2202007048	VA

General Provider Information

NPI Number	:	1972942803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY M SHEPHERD

Provider Business Mailing Address
First Line	:	8348 TRAFORD LN STE 200
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1650
Country	:	US
Telephone Number	:	703-569-7500
Fax Number	:	703-866-0158

Provider Business Practice Location Address
First Line	:	8348 TRAFORD LN
Second Line	:	200
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1663
Country	:	US
Telephone Number	:	703-569-7500
Fax Number	:	703-866-0158

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

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	02/04/2026

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Directions to “ KELLY M SHEPHERD ” Practice Location

Language	Start Address	Practice Location

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