Provider Demographics
NPI:1114222825
Name:SHIPE, DOREEN (MA)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:
Last Name:SHIPE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6786 NW 43RD PL
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3003
Mailing Address - Country:US
Mailing Address - Phone:954-341-9156
Mailing Address - Fax:
Practice Address - Street 1:6786 NW 43RD PL
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3003
Practice Address - Country:US
Practice Address - Phone:954-341-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 2874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist