1922068485 NPI number — LINDSAY T SHEPARD PA-C

Table of content: LINDSAY T SHEPARD PA-C (NPI 1922068485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922068485 NPI number — LINDSAY T SHEPARD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEPARD
Provider First Name:
LINDSAY
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCINTYRE
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922068485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
298 ARMISTICE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02861-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-473-1015
Provider Business Mailing Address Fax Number:
508-634-0261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 MILFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-473-1015
Provider Business Practice Location Address Fax Number:
508-634-0261
Provider Enumeration Date:
03/27/2006

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: 363A00000X , with the licence number:  1979 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 99546 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".




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