Provider Demographics
NPI:1285624247
Name:CHIPPENDALE, MAURA L (AUD, FAAA)
Entity type:Individual
Prefix:MS
First Name:MAURA
Middle Name:L
Last Name:CHIPPENDALE
Suffix:
Gender:F
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 BROOKSHIRE TER
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4239
Mailing Address - Country:US
Mailing Address - Phone:239-994-8322
Mailing Address - Fax:
Practice Address - Street 1:1224 DEL PRADO BLVD S
Practice Address - Street 2:SUITE C
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3670
Practice Address - Country:US
Practice Address - Phone:239-772-0940
Practice Address - Fax:239-677-3606
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY-302231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS1471Medicare ID - Type Unspecified
CE800YMedicare UPIN