Provider Demographics
NPI:1184074205
Name:SHEPPARD, TANYA IRENE (C-NP)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:IRENE
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:C-NP
Other - Prefix:MRS
Other - First Name:TANYA
Other - Middle Name:IRENE
Other - Last Name:MAKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C-NP
Mailing Address - Street 1:24651 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5635
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:
Practice Address - Street 1:7215 OLD OAK BLVD STE A420
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-895-5058
Practice Address - Fax:440-816-6999
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.19234-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0175501Medicaid
OH0175501Medicaid