Provider Demographics
NPI:1043018625
Name:SHEARD, DEMETRIA LALITA
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:LALITA
Last Name:SHEARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S 17TH ST STE 233
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2040
Mailing Address - Country:US
Mailing Address - Phone:402-403-1367
Mailing Address - Fax:
Practice Address - Street 1:319 S 17TH ST STE 233
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2040
Practice Address - Country:US
Practice Address - Phone:402-403-1367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2243101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)