Basic Information
| Provider Information | |||||||||
| NPI: | 1881783280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEPARDSON | ||||||||
| FirstName: | ALETHEA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | RNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 W 94TH ST | ||||||||
| Address2: | APT. 14J | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100256954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189205544 | ||||||||
| FaxNumber: | 7189205202 | ||||||||
| Practice Location | |||||||||
| Address1: | CLINICAL DIABETES CENTER | ||||||||
| Address2: | 3411 WAYNE AVENUE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189205544 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F331744 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.