Individual
MARY T SHEPPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1001 MAIN ST FL 4, BUFFALO, NY 14203-1009
(716) 323-0110
(716) 323-0296
Mailing address
1001 MAIN ST FL 5, BUFFALO, NY 14203-1009
(716) 323-0110
(716) 332-0296
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F380546
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02344723
—
NY
01
—
071112000039
FIDELIS
—
01
—
080407000110
FIDELIS
—
Enumeration date
04/24/2006
Last updated
05/16/2023
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