Healthcare Provider Details

I. General information

NPI: 1639211501
Provider Name (Legal Business Name): L D SHIPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 NW 4TH BLVD #49
GAINESVILLE FL
32607-1600
US

IV. Provider business mailing address

7257 NW 4TH BLVD #49
GAINESVILLE FL
32607-1600
US

V. Phone/Fax

Practice location:
  • Phone: 352-378-2351
  • Fax: 352-371-4601
Mailing address:
  • Phone: 352-378-2351
  • Fax: 352-371-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS1671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: