Provider Demographics
NPI:1235109612
Name:SHEPPARD-LABRECQUE, VICTORIA L (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:SHEPPARD-LABRECQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 E CACTUS RD STE 940
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4848 E CACTUS RD STE 940
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4164
Practice Address - Country:US
Practice Address - Phone:480-443-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ564542080P0006X
SC379042080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC379049Medicaid
SCSC53657951Medicare PIN
SCPENDINGMedicare PIN
NC891117HMedicaid