Individual provider · Type 1 NPI

Angel J. Shepherd

Licensed Practical Nurse · Watertown, NY

NPI number 1073402335 Active

Practice location

650 State St
Watertown, NY 13601-2839

Fax (315) 291-6601

Mailing address

324 County Route 51 Bldg 1
Malone, NY 12953-4502

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse Primary 164W00000X353253 (NY)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1073402335

Angel J. Shepherd's National Provider Identifier is 1073402335, issued on Jul 1, 2025. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Watertown, NY. The record was last updated on Jul 1, 2025.