Provider Demographics
NPI:1639211501
Name:SHIPP, L D
Entity Type:Individual
Prefix:
First Name:L
Middle Name:D
Last Name:SHIPP
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 1:7257 NW 4TH BLVD
Mailing Address - Street 2:#49
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1600
Mailing Address - Country:US
Mailing Address - Phone:352-378-2351
Mailing Address - Fax:352-371-4601
Practice Address - Street 1:7257 NW 4TH BLVD
Practice Address - Street 2:#49
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1600
Practice Address - Country:US
Practice Address - Phone:352-378-2351
Practice Address - Fax:352-371-4601
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS1671237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL610058900Medicaid