Active NPI
Diamond Dawn Shepard, LMT
- Massage Therapist
- Hazel Crest, IL
National Provider Identifier
1083344212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 227022203
- Practice address
- 17004 Novak Dr
Hazel Crest, IL 60429-1156 - Phone
- (708) 739-6990
- NPI assigned
- Jun 11, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 227022203 | IL | Primary |
Addresses
Primary practice location
17004 Novak Dr
Hazel Crest, IL 60429-1156
Mailing address
17004 Novak Dr
Hazel Crest, IL 60429-1156
Phone (708) 739-6990
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 227022203 | IL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658448000000",
"number": "1083344212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17004 NOVAK DR",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604291156",
"telephone_number": "708-739-6990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17004 NOVAK DR",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604291156",
"telephone_number": "708-739-6990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPARD",
"first_name": "DIAMOND",
"middle_name": "DAWN",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-11",
"last_updated": "2022-07-22",
"certification_date": "2022-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": "227022203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hazel Crest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.