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General NPI Number Information
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NPI Number | 1053046896
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Entity Type | Individual
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Provider Name | CHASITY A SHIPMAN
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Gender | Female
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Dates
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Enumeration Date | 07/17/2022
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Last Update Date | 07/17/2022
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Provider Practice Location Address
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Address Line | 1144 MOSELEY AVE
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City | IRMO
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State | SC
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Zip | 29063-2787
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Country | US
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Telephone | 803-244-9369
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Fax |
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Provider Business Mailing Address
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Address Line | 266 CAEDMONS CREEK DR
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City | IRMO
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State | SC
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Zip | 29063-7100
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Country | US
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Telephone | 803-528-0031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 70244
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License Number State | SC
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