Provider Demographics
NPI:1972808509
Name:SHEPPARD, DEBRA FRANCES (ANP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:FRANCES
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1705
Mailing Address - Country:US
Mailing Address - Phone:631-608-5655
Mailing Address - Fax:631-396-0468
Practice Address - Street 1:399 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1705
Practice Address - Country:US
Practice Address - Phone:631-608-5655
Practice Address - Fax:631-396-0468
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302739363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health