Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 001040 | CT |
NPI | 1013052430 |
---|---|
Provider Name | Miss Sandra Shipkowitz |
First Address | Bridgeport, CT 06610-2805 |
Second Address | Bridgeport, CT 06610-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |