Provider Demographics
NPI:1568262343
Name:SHEPARD, DESIRAE DEONNA
Entity type:Individual
Prefix:
First Name:DESIRAE
Middle Name:DEONNA
Last Name:SHEPARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 BRINKLEY RD APT 102
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6042
Mailing Address - Country:US
Mailing Address - Phone:240-606-9548
Mailing Address - Fax:
Practice Address - Street 1:5914 SEMINARY RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3012
Practice Address - Country:US
Practice Address - Phone:703-820-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker