MEDICARE: DR. SARA SHUMATE D.D.S.

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	122300000X	Dentist	DN11698	FL

General Provider Information

NPI Number	:	1629191077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA SHUMATE D.D.S.

Provider Business Mailing Address
First Line	:	836 S US HIGHWAY 1
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-4703
Country	:	US
Telephone Number	:	772-778-1446
Fax Number	:	772-778-1102

Provider Business Practice Location Address
First Line	:	836 S US HIGHWAY 1
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-4703
Country	:	US
Telephone Number	:	772-778-1446
Fax Number	:	772-778-1102

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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