=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598638033
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL SHUPING
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2025
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 MEDICAL CENTER DR
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28401-7305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-756-3447
-----------------------------------------------------
Fax | 317-520-8200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 DEPAUW BLVD STE 3070
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46268-6135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-324-0885
-----------------------------------------------------
Fax | 317-520-8200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-24-77339
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------