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NPI Code Detail

MEDICARE: MALLORY SHUPE

MEDICARE: MALLORY SHUPE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1205391117
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY SHUPE
Provider Business Mailing Address
First Line : 4935 HILLEGAS RD STE 200
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-1943
Country : US
Telephone Number : 260-338-1241
Fax Number :
Provider Business Practice Location Address
First Line : 4935 HILLEGAS RD STE 200
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-1943
Country : US
Telephone Number : 260-338-1241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2019
Last Update Date : 02/05/2019

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Directions to “ MALLORY SHUPE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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