Provider Demographics
NPI:1639969488
Name:SHIPSEY, MIRANDA ROSE (MS CF-SLP TSSLD-BE)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ROSE
Last Name:SHIPSEY
Suffix:
Gender:
Credentials:MS CF-SLP TSSLD-BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 38TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2618
Mailing Address - Country:US
Mailing Address - Phone:631-662-8503
Mailing Address - Fax:
Practice Address - Street 1:535 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3620
Practice Address - Country:US
Practice Address - Phone:718-948-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist