Individual
JOSEPH SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, RD/LD
Contact information
Practice address
11050 MOUNT BELVEDERE BLVD, FORT DRUM, NY 13602-5438
(405) 269-3154
Mailing address
10728 HARRIS RD, CARTHAGE, NY 13619-8594
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2380
OK
Other
Enumeration date
03/10/2019
Last updated
11/11/2022
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