| NPI | 1982031159 |
|---|---|
| Former Name | SANDRA LYNN SHEPHERD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 5070) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 017044) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2023-02-06 |