Healthcare Provider Details

I. General information

NPI: 1265268221
Provider Name (Legal Business Name): ZACHARY RYAN SHIPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9833 PATRIOT HWY
FREDERICKSBURG VA
22407-9422
US

IV. Provider business mailing address

4201 BRIDLEPATH CT
FREDERICKSBURG VA
22408-8813
US

V. Phone/Fax

Practice location:
  • Phone: 540-847-1936
  • Fax:
Mailing address:
  • Phone: 540-847-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: