Provider Demographics
NPI:1962794511
Name:PIPKIN, SHAHANA ELLEN
Entity type:Individual
Prefix:MRS
First Name:SHAHANA
Middle Name:ELLEN
Last Name:PIPKIN
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 1:2480 LIBERTY STREET NE,
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8380
Mailing Address - Country:US
Mailing Address - Phone:503-371-1970
Mailing Address - Fax:503-371-0192
Practice Address - Street 1:2480 LIBERTY STREET NE,
Practice Address - Street 2:SUITE 160
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8380
Practice Address - Country:US
Practice Address - Phone:503-371-1970
Practice Address - Fax:503-371-0192
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator