Provider Demographics
NPI:1962936310
Name:SHEPARD, KATHLEEN BERNADETTE
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BERNADETTE
Last Name:SHEPARD
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 1:40833 INGERSOLL TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3581
Mailing Address - Country:US
Mailing Address - Phone:415-328-8497
Mailing Address - Fax:
Practice Address - Street 1:40833 INGERSOLL TER
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-3581
Practice Address - Country:US
Practice Address - Phone:415-328-8497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program