Provider Demographics
NPI:1538365739
Name:SHEPARD, ELIZABETH LAUREN (ITDS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAUREN
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 1ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIAN ROCKS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33785-3134
Mailing Address - Country:US
Mailing Address - Phone:813-464-1810
Mailing Address - Fax:
Practice Address - Street 1:2708 1ST ST
Practice Address - Street 2:
Practice Address - City:INDIAN ROCKS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33785-3134
Practice Address - Country:US
Practice Address - Phone:813-464-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist