Provider Demographics
NPI:1427149988
Name:SHEPHERD, STEVEN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WILLIAM
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4861
Mailing Address - Country:US
Mailing Address - Phone:631-289-7268
Mailing Address - Fax:631-475-1969
Practice Address - Street 1:286 PATCHOGUE YAPHANK RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4861
Practice Address - Country:US
Practice Address - Phone:631-289-7268
Practice Address - Fax:631-475-1969
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4412774OtherAETNA
NYCP567OtherOXFORD
NY0F210POtherHIP
NY2436OtherVYTRA
NY4412774OtherAETNA
NY24D821Medicare PIN
NY0F210POtherHIP