Provider Demographics
NPI:1861911364
Name:SHEPARD, MILAGROS ROCIO (PA-C)
Entity type:Individual
Prefix:
First Name:MILAGROS
Middle Name:ROCIO
Last Name:SHEPARD
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 1:603 BROCKMAN CT
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-1132
Mailing Address - Country:US
Mailing Address - Phone:703-975-9824
Mailing Address - Fax:
Practice Address - Street 1:1359 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3666
Practice Address - Country:US
Practice Address - Phone:703-893-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-005873363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical