Provider Demographics
NPI:1528125168
Name:SHEPHARD, CARROLL ANNE (PHD)
Entity type:Individual
Prefix:MS
First Name:CARROLL
Middle Name:ANNE
Last Name:SHEPHARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:CARROLL
Other - Middle Name:SWAXSON
Other - Last Name:SHEPHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:14502 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2075
Mailing Address - Country:US
Mailing Address - Phone:813-402-2926
Mailing Address - Fax:813-402-2927
Practice Address - Street 1:14502 NORTH DALE MABRY
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:813-402-2926
Practice Address - Fax:813-402-2927
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75487Medicare PIN