Provider Demographics
NPI:1144732140
Name:SHEPPARD, CAROLINE (PA-C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N STATE ST STE 900
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-9104
Mailing Address - Country:US
Mailing Address - Phone:312-245-9965
Mailing Address - Fax:312-245-9964
Practice Address - Street 1:515 N STATE ST STE 900
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-9104
Practice Address - Country:US
Practice Address - Phone:312-245-9965
Practice Address - Fax:312-245-9964
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant