Provider Demographics
NPI:1174859201
Name:SHEPPY, WILLARD (LAC)
Entity type:Individual
Prefix:
First Name:WILLARD
Middle Name:
Last Name:SHEPPY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 27TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-4165
Mailing Address - Country:US
Mailing Address - Phone:541-760-9670
Mailing Address - Fax:
Practice Address - Street 1:614 27TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-4165
Practice Address - Country:US
Practice Address - Phone:541-760-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-24
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150425171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist