Provider Demographics
NPI:1295003572
Name:CANIPE, ANDRE SCOTT (CSA)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:SCOTT
Last Name:CANIPE
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 E MARION ST
Mailing Address - Street 2:APT. 809
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6264
Mailing Address - Country:US
Mailing Address - Phone:704-477-0423
Mailing Address - Fax:
Practice Address - Street 1:1829 E MARION ST
Practice Address - Street 2:APT. 809
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6264
Practice Address - Country:US
Practice Address - Phone:704-477-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3810246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant