Healthcare Provider Details

I. General information

NPI: 1548096548
Provider Name (Legal Business Name): ROSS SHUMWAY RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD BLDG 1130
LUKE AIR FORCE BASE AZ
85309-1529
US

IV. Provider business mailing address

7219 N LITCHFIELD RD BLDG 1130
LUKE AIR FORCE BASE AZ
85309-1529
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-2296
  • Fax:
Mailing address:
  • Phone: 623-856-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86076439
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: