Healthcare Provider Details

I. General information

NPI: 1396046215
Provider Name (Legal Business Name): RICHARD SCOTT SHIPLEY NBC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DOVER MALL,MIRACLE EAR/SEARS/ ROUTE 13 NORTH DUPONT HWY.
DOVER DE
19901
US

IV. Provider business mailing address

111 PARK AVE. BOX 1117
RIDGELY MD
21660
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-3280
  • Fax:
Mailing address:
  • Phone: 302-678-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number03-0000175
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: