Provider Demographics
NPI:1528153889
Name:SHEPARD, CECILE (DPM)
Entity type:Individual
Prefix:
First Name:CECILE
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 APRIL CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2485 HIGH SCHOOL AVE STE 222
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1813
Practice Address - Country:US
Practice Address - Phone:925-372-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2844213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28441OtherMEDICARE PROVIDER NUMBER NOT SPECIFIED
CAZZZ01511ZMedicare ID - Type UnspecifiedADOBE FOOT CLINIC
CA000E28440Medicare PIN
CA000E28441OtherMEDICARE PROVIDER NUMBER NOT SPECIFIED