Provider Demographics
NPI:1376844498
Name:SHIMP, ADRIENNE
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:
Last Name:SHIMP
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 1:620 HOFFNAGLE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-1945
Mailing Address - Country:US
Mailing Address - Phone:215-342-1039
Mailing Address - Fax:
Practice Address - Street 1:620 HOFFNAGLE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-1945
Practice Address - Country:US
Practice Address - Phone:215-342-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist