Individual
STACEY T SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5645 STONE RD, CENTREVILLE, VA 20120-1618
(703) 266-2442
(703) 266-7158
Mailing address
6705 JACKPIN PL, GAINESVILLE, VA 20155-4459
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110001525
VA
Other
Enumeration date
09/24/2006
Last updated
07/08/2007
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