Provider Demographics
NPI:1700514908
Name:BOPPANA, SHILPA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:
Last Name:BOPPANA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 CROSSGATE PL
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3116
Mailing Address - Country:US
Mailing Address - Phone:205-478-7176
Mailing Address - Fax:
Practice Address - Street 1:2505 CROSSGATE PL
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-3116
Practice Address - Country:US
Practice Address - Phone:205-478-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical