Individual
ELIZABETH ANNE SHEPPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
8725 N WICKHAM RD STE 202, MELBOURNE, FL 32940-2240
(321) 434-9528
(321) 434-9529
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-9528
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9105602
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003181500
—
FL
01
—
NR566
FL MEDICARE
FL
01
—
PA9105602
LICENSE
FL
Enumeration date
12/13/2010
Last updated
05/14/2021
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