Individual
VICTORIA STORM SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4180 WARRENSVILLE CENTER RD, 120, BEACHWOOD, OH 44122-7024
(440) 834-1833
(440) 834-1902
Mailing address
PO BOX 391405, SOLON, OH 44139-8405
(216) 496-4433
(440) 834-1902
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50001447
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50001447
LICENSE
OH
01
—
9357511
MEDICARE GROUP
OH
Enumeration date
04/05/2006
Last updated
12/29/2009
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