Basic Information
Provider Information | |||||||||
NPI: | 1518057868 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHIPLEY | ||||||||
FirstName: | MELISSA | ||||||||
MiddleName: | FAITH GAME | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GAME | ||||||||
OtherFirstName: | MELISSA | ||||||||
OtherMiddleName: | FAITH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1729 NEW HANOVER MEDICAL PARK DR | ||||||||
Address2: |   | ||||||||
City: | WILMINGTON | ||||||||
State: | NC | ||||||||
PostalCode: | 284035345 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9107633601 | ||||||||
FaxNumber: | 9107634608 | ||||||||
Practice Location | |||||||||
Address1: | 1729 NEW HANOVER MEDICAL PARK DR | ||||||||
Address2: |   | ||||||||
City: | WILMINGTON | ||||||||
State: | NC | ||||||||
PostalCode: | 284035345 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9107633601 | ||||||||
FaxNumber: | 9107634608 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/14/2006 | ||||||||
LastUpdateDate: | 10/27/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/27/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | TL31580 | SC | N |   | Allopathic & Osteopathic Physicians | Ophthalmology |   | 207W00000X | 2010-01132 | NC | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
No ID Information.