Provider Demographics
NPI:1528456738
Name:MAEGAN SHEPHERD
Entity type:Organization
Organization Name:MAEGAN SHEPHERD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IOM TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAEGAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-851-5517
Mailing Address - Street 1:4 ROCKLAND CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5006
Mailing Address - Country:US
Mailing Address - Phone:817-851-5517
Mailing Address - Fax:817-394-4353
Practice Address - Street 1:4 ROCKLAND CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5006
Practice Address - Country:US
Practice Address - Phone:817-851-5517
Practice Address - Fax:817-394-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty