1528125168 NPI number — MS. CARROLL ANNE SHEPHARD PH.D.

Table of content: MS. CARROLL ANNE SHEPHARD PH.D. (NPI 1528125168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528125168 NPI number — MS. CARROLL ANNE SHEPHARD PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEPHARD
Provider First Name:
CARROLL
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEPHARD
Provider Other First Name:
CARROLL
Provider Other Middle Name:
SWAXSON
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528125168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14502 N DALE MABRY HWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33618-2075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-402-2926
Provider Business Mailing Address Fax Number:
813-402-2927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14502 NORTH DALE MABRY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-402-2926
Provider Business Practice Location Address Fax Number:
813-402-2927
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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