Provider Demographics
NPI:1164266417
Name:SHIPE, STACEY L (PHD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:L
Last Name:SHIPE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8910
Mailing Address - Country:US
Mailing Address - Phone:347-731-6065
Mailing Address - Fax:
Practice Address - Street 1:16 CINEMA DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1674
Practice Address - Country:US
Practice Address - Phone:327-471-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker