Provider Demographics
NPI:1023639994
Name:SHIPWAY, HALEY CHARLOTTE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:CHARLOTTE
Last Name:SHIPWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 SANDALWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5509
Mailing Address - Country:US
Mailing Address - Phone:925-286-5402
Mailing Address - Fax:
Practice Address - Street 1:1426 FILLMORE ST STE 216
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4164
Practice Address - Country:US
Practice Address - Phone:415-561-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-02
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program