Provider Demographics
NPI:1689548489
Name:WATSON, SHEPARD
Entity type:Individual
Prefix:
First Name:SHEPARD
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360595
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-6595
Mailing Address - Country:US
Mailing Address - Phone:781-215-5311
Mailing Address - Fax:781-865-5165
Practice Address - Street 1:511 NEW HIGHWAY 96 W # 103
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2554
Practice Address - Country:US
Practice Address - Phone:615-552-7080
Practice Address - Fax:516-299-6097
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician