Individual
MADISON NICOLE SHEPPARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
739 GRAHAM RD, CUYAHOGA FALLS, OH 44221-1056
(330) 929-7002
Mailing address
1305 MAXFLI DR, AKRON, OH 44312-5380
(330) 612-0447
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.006682RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1175257
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS (NCCPA)
—
01
—
50.006682RX
STATE MEDICAL BOARD OF OHIO
OH
Enumeration date
09/16/2020
Last updated
06/12/2024
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