Provider Demographics
NPI:1396046215
Name:SHIPLEY, RICHARD SCOTT (NBC-HIS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SCOTT
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PARK AVE.
Mailing Address - Street 2:BOX 1117
Mailing Address - City:RIDGELY
Mailing Address - State:MD
Mailing Address - Zip Code:21660
Mailing Address - Country:US
Mailing Address - Phone:302-678-3280
Mailing Address - Fax:
Practice Address - Street 1:1000 DOVER MALL,MIRACLE EAR/SEARS/
Practice Address - Street 2:ROUTE 13 NORTH DUPONT HWY.
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-678-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE03-0000175237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist