Provider Demographics
NPI:1043631278
Name:SHIPE, BEVERLY ANN (NP)
Entity type:Individual
Prefix:
First Name:BEVERLY ANN
Middle Name:
Last Name:SHIPE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PARK LANE COURT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5018
Mailing Address - Country:US
Mailing Address - Phone:716-632-3455
Mailing Address - Fax:
Practice Address - Street 1:37 PARK LANE COURT
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5018
Practice Address - Country:US
Practice Address - Phone:716-632-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286382363LP0200X, 363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool