Healthcare Provider Details

I. General information

NPI: 1629320957
Provider Name (Legal Business Name): FIFTH CHIP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 DEL PRADO BLVD S SUITE C
CAPE CORAL FL
33990-3670
US

IV. Provider business mailing address

1224 DEL PRADO BLVD S STE C
CAPE CORAL FL
33990-3670
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-0940
  • Fax: 239-677-3606
Mailing address:
  • Phone: 239-772-0940
  • Fax: 239-677-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY302
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY302
License Number StateFL

VIII. Authorized Official

Name: MS. MAURA LYNNE CHIPPENDALE
Title or Position: AUDIOLOGIST/PRESIDENT
Credential: AUD., FAAA
Phone: 239-772-0940