53D1004077 CLIA NUMBER - SHELLEY M SHEPARD MD PC

Laboratory Demographics

  • CLIA Code: 53D1004077
  • Facility Name: SHELLEY M SHEPARD MD PC
  • Facility Address: 1206 WEST FOURTH STREET SUITE 1
    GILLETTE, WY
    ZIP 82716
  • Facility Phone: 307 685-0130
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SHELLEY M. SHEPARD
  • NPI Number: 1992701148
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 53D1004077
LAB Type Physician Office
Facility Name SHELLEY M SHEPARD MD PC
Street 1206 WEST FOURTH STREET SUITE 1
City GILLETTE
State WY
ZIP 82716
Phone 307 685-0130
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/18/2024
Certificate Expiration Date 9/17/2026
Facility Type Physician Office
Lab Director SHELLEY M. SHEPARD

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This page was last updated on: 9/29/2025