Individual
SHEPPARD WEBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 MEETING HOUSE LN, SOUTHAMPTON, NY 11968-5087
(631) 371-1410
(631) 938-9145
Mailing address
23 PHEASANT LN, EAST SETAUKET, NY 11733-2634
(631) 371-1410
(631) 938-9145
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
204395
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD432102
MEDICAL LICENSE
PA
Enumeration date
12/03/2007
Last updated
01/13/2017
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