Provider Demographics
NPI:1992542377
Name:SHEAPRD, COREY
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:SHEAPRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3548
Mailing Address - Country:US
Mailing Address - Phone:682-232-9881
Mailing Address - Fax:
Practice Address - Street 1:1124 WAVERLY DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3548
Practice Address - Country:US
Practice Address - Phone:682-232-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No175T00000XOther Service ProvidersPeer Specialist