Individual
TEQUILLA SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1530 NE 22ND ST, WINSTON SALEM, NC 27105-5406
(443) 254-8361
Mailing address
1530 NE 22ND ST, WINSTON SALEM, NC 27105-5406
(443) 254-8361
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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