Provider Demographics
NPI:1679375315
Name:SHEPPARD, JUSTIN JEROME
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JEROME
Last Name:SHEPPARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WESTSIDE HOSPITAL 8201 WEST BROWARD BLVD PLANTATION, FL
Mailing Address - Street 2:ARNIECE GUTIERREZ
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WESTSIDE HOSPITAL 8201 WEST BROWARD BLVD PLANTATION, FL
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-473-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program