Provider Demographics
NPI:1659740215
Name:SHIPP-WILSON, SANDRA LAYNETTE
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LAYNETTE
Last Name:SHIPP-WILSON
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 1:1714 FERNDALE RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3234
Mailing Address - Country:US
Mailing Address - Phone:330-453-0326
Mailing Address - Fax:
Practice Address - Street 1:1714 FERNDALE RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3234
Practice Address - Country:US
Practice Address - Phone:330-453-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide