Provider Demographics
NPI:1114191350
Name:THE AUTISM SHOPPE
Entity Type:Organization
Organization Name:THE AUTISM SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:ROXANNE
Authorized Official - Last Name:GADAINGAN SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-242-0942
Mailing Address - Street 1:506 HOPEWELL DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-2228
Mailing Address - Country:US
Mailing Address - Phone:302-242-0942
Mailing Address - Fax:302-223-6737
Practice Address - Street 1:506 HOPEWELL DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:DE
Practice Address - Zip Code:19938-2228
Practice Address - Country:US
Practice Address - Phone:302-242-0942
Practice Address - Fax:302-223-6737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2006207052332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies