Healthcare Provider Details

I. General information

NPI: 1831011691
Provider Name (Legal Business Name): CANDICE SHIPLEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 RODGERS FORGE RD APT C
BALTIMORE MD
21212-1316
US

IV. Provider business mailing address

213 RODGERS FORGE RD APT C
BALTIMORE MD
21212-1316
US

V. Phone/Fax

Practice location:
  • Phone: 443-775-0328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: