Provider Demographics
NPI:1902237019
Name:SHIPLEY, CARA (RD)
Entity Type:Individual
Prefix:MISS
First Name:CARA
Middle Name:
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 HUTSCHENREUTER LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9333
Mailing Address - Country:US
Mailing Address - Phone:443-797-2841
Mailing Address - Fax:
Practice Address - Street 1:6124 HUTSCHENREUTER LN
Practice Address - Street 2:
Practice Address - City:GLEN ARM
Practice Address - State:MD
Practice Address - Zip Code:21057-9333
Practice Address - Country:US
Practice Address - Phone:443-797-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3566133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric