Provider Demographics
NPI:1104991256
Name:SHEPHARD, ROJDAH S (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:ROJDAH
Middle Name:S
Last Name:SHEPHARD
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 S JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1414
Mailing Address - Country:US
Mailing Address - Phone:720-941-7465
Mailing Address - Fax:
Practice Address - Street 1:775 S JERSEY ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1414
Practice Address - Country:US
Practice Address - Phone:720-941-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-12775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily