Provider Demographics
NPI:1417539230
Name:SHEPARD, ALISSA SABATINO (DO)
Entity type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:SABATINO
Last Name:SHEPARD
Suffix:
Gender:
Credentials:DO
Other - Prefix:DR
Other - First Name:ALISSA
Other - Middle Name:MARIE
Other - Last Name:SABATINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2512 CHARDONNAY LN
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-8201
Mailing Address - Country:US
Mailing Address - Phone:602-819-1145
Mailing Address - Fax:
Practice Address - Street 1:1800 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6019
Practice Address - Country:US
Practice Address - Phone:209-943-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR3630208600000X
390200000X
CA20A21055207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program