Healthcare Provider Details

I. General information

NPI: 1376967455
Provider Name (Legal Business Name): MARTHA SHUMWAY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 MARIPOSA ST STE 100
SAN FRANCISCO CA
94110-1472
US

IV. Provider business mailing address

2727 MARIPOSA ST STE 100
SAN FRANCISCO CA
94110-1472
US

V. Phone/Fax

Practice location:
  • Phone: 415-437-3077
  • Fax:
Mailing address:
  • Phone: 415-437-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: