Individual
MR. JOHN JOSEPH SHEPPARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
42 DEANE ST, WADING RIVER, NY 11792-1805
(631) 456-9748
Mailing address
42 DEANE ST, WADING RIVER, NY 11792-1805
(631) 456-9748
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
016308-1
NY
Other
Enumeration date
01/15/2013
Last updated
01/15/2013
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