Stacey T Shepherd, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110001525 Issued in VA

Practice address

5645 Stone Rd
Centreville, VA 20120-1618

Phone

(703) 266-2442

Fax

(703) 266-7158

NPI assigned

Sep 24, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: stacey.shepherd.1@17026.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679673255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6705 JACKPIN PL",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201554459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 STONE RD",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201201618",
            "telephone_number": "703-266-2442",
            "fax_number": "703-266-7158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "STACEY",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110001525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sumaira Shakir, DO
• Shangri-la Integrated Clinic
• Kathleen Shearer, ANP
• Sheela M. Kadekar, M.D. P.L.L.C.
• Nimo Sheikh-Adam
• Matthew Jaesik Shin, D.C.
• Yongkyo Shin
• Melissa Short, M.A. CFY-SLP
• Christiane Shousha
• Shue Jen Chuang D.D.S. & David W. Lucht D.D.S. PLC

• Medical Physician Assistant in Centreville, VA
• Providers in Centreville, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.