Provider Demographics
NPI:1457096026
Name:SHEPHERD, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 FORRESTAL DR
Mailing Address - Street 2:BLDG NH-33
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23551-2400
Mailing Address - Country:US
Mailing Address - Phone:757-836-1552
Mailing Address - Fax:
Practice Address - Street 1:1775 FORRESTAL DR
Practice Address - Street 2:BLDG NH-33
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23551-2400
Practice Address - Country:US
Practice Address - Phone:757-836-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71415207P00000X
390200000X
VA0101286146207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program