Provider Demographics
NPI:1154176196
Name:SHEPARD, CHERYL (RN,MSN ED,PMH-BC,PHN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:RN,MSN ED,PMH-BC,PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8690 AERO DR STE 115-219
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1886
Mailing Address - Country:US
Mailing Address - Phone:619-432-7655
Mailing Address - Fax:
Practice Address - Street 1:8690 AERO DR STE 115-219
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1886
Practice Address - Country:US
Practice Address - Phone:619-432-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 174H00000X
CA95047139163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator