Provider Demographics
NPI:1053046896
Name:SHIPMAN, CHASITY A
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:A
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 CAEDMONS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7100
Mailing Address - Country:US
Mailing Address - Phone:803-528-0031
Mailing Address - Fax:
Practice Address - Street 1:1144 MOSELEY AVE
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2787
Practice Address - Country:US
Practice Address - Phone:803-244-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC70244335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier