Healthcare Provider Details

I. General information

NPI: 1396422077
Provider Name (Legal Business Name): CASSANDRA JAYNE SHIPP AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 MEDICAL PKWY STE 320
AUSTIN TX
78705-1023
US

IV. Provider business mailing address

3705 MEDICAL PKWY STE 320
AUSTIN TX
78705-1023
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-0392
  • Fax: 512-371-7098
Mailing address:
  • Phone: 512-454-0392
  • Fax: 512-371-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81535
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: