Provider Demographics
NPI:1184830580
Name:SHIPMAN, SHEILA LEE (IDC)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:LEE
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 BEASLEY RD APT 5F
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5032
Mailing Address - Country:US
Mailing Address - Phone:228-383-5888
Mailing Address - Fax:228-871-2135
Practice Address - Street 1:NMCB SEVEN
Practice Address - Street 2:UNIT 60252
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:34099-5061
Practice Address - Country:US
Practice Address - Phone:228-871-2810
Practice Address - Fax:228-871-2135
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman