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General NPI Number Information
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NPI Number | 1033397302
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Entity Type | Organization
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Legal Business Name | STUART S. SHIPE, D.O.M., P.A.
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 1801 SE HILLMOOR DR SUITE A104
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7553
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Country | US
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Telephone | 772-398-4550
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Fax | 772-398-4552
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Provider Business Mailing Address
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Address Line | 1801 SE HILLMOOR DR SUITE A104
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7553
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Country | US
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Telephone | 772-398-4550
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Fax | 772-398-4552
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Authorized Official
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Title or Position | ACUPUNCTURE PHYSICIAN
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Name | STUART S SHIPE
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Credential | D.O.M.
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Telephone | 772-398-4550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS22540
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP1627
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License Number State | FL
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