MEDICARE: MARY MASON SHUMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	31370	SC

General Provider Information

NPI Number	:	1407453699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MASON SHUMAN

Provider Business Mailing Address
First Line	:	47 VINCENT DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-4003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1952 LONG GROVE DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-7579
Country	:	US
Telephone Number	:	843-800-2377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	02/12/2026

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