Active NPI
John Joseph Sheppard, PA-C
- Medical Physician Assistant
- Wading River, NY
National Provider Identifier
1386981090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 016308-1
- Practice address
- 42 Deane St
Wading River, NY 11792-1805 - Phone
- (631) 456-9748
- NPI assigned
- Jan 15, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 016308-1 | NY | Primary |
Addresses
Primary practice location
42 Deane St
Wading River, NY 11792-1805
Mailing address
42 Deane St
Wading River, NY 11792-1805
Phone (631) 456-9748
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016308-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358208000000",
"number": "1386981090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 DEANE ST",
"city": "WADING RIVER",
"state": "NY",
"postal_code": "117921805",
"telephone_number": "631-456-9748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42 DEANE ST",
"city": "WADING RIVER",
"state": "NY",
"postal_code": "117921805",
"telephone_number": "631-456-9748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPPARD",
"first_name": "JOHN",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-15",
"last_updated": "2013-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "016308-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wading River, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.