Healthcare Provider Details

I. General information

NPI: 1730789983
Provider Name (Legal Business Name): NOEL SHIPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 16TH ST
PHILADELPHIA PA
19102-4908
US

IV. Provider business mailing address

910 S 49TH ST APT 1
PHILADELPHIA PA
19143-3404
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-8244
  • Fax:
Mailing address:
  • Phone: 609-477-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number137210
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: