Provider Demographics
NPI:1871360628
Name:SHEPPARD, LAUREN HOLLEY
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:HOLLEY
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GINGER CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1110
Mailing Address - Country:US
Mailing Address - Phone:716-984-1467
Mailing Address - Fax:
Practice Address - Street 1:24 GINGER CT
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1110
Practice Address - Country:US
Practice Address - Phone:716-984-1467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program