Provider Demographics
NPI:1063011765
Name:SHEPPARD, BRYON A
Entity type:Individual
Prefix:
First Name:BRYON
Middle Name:A
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2485
Mailing Address - Country:US
Mailing Address - Phone:925-822-2679
Mailing Address - Fax:
Practice Address - Street 1:29516 KOHOUTEK WAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1221
Practice Address - Country:US
Practice Address - Phone:510-441-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech