Provider Demographics
NPI:1629379870
Name:SHIPKO, STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:SHIPKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 W BELLEVUE DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2501
Mailing Address - Country:US
Mailing Address - Phone:626-577-8290
Mailing Address - Fax:626-795-3527
Practice Address - Street 1:97 W BELLEVUE DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2501
Practice Address - Country:US
Practice Address - Phone:626-577-8290
Practice Address - Fax:626-795-3527
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG429862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry