Provider Demographics
NPI:1902685217
Name:SHEPPARD, RAZEL
Entity Type:Individual
Prefix:
First Name:RAZEL
Middle Name:
Last Name:SHEPPARD
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 1:3626 N HALL ST STE 610
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5131
Mailing Address - Country:US
Mailing Address - Phone:469-915-9133
Mailing Address - Fax:469-915-9134
Practice Address - Street 1:1616 BROOKSTONE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5763
Practice Address - Country:US
Practice Address - Phone:214-946-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver