Healthcare Provider Details

I. General information

NPI: 1265409031
Provider Name (Legal Business Name): PAMELA L SHUMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 N MAIN ST
DANIELSON CT
06239-1405
US

IV. Provider business mailing address

189 STORRS RD
MANSFIELD CENTER CT
06250-1683
US

V. Phone/Fax

Practice location:
  • Phone: 860-779-2101
  • Fax: 860-779-3807
Mailing address:
  • Phone: 860-456-1311
  • Fax: 860-423-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number047955
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9144
License Number StateRI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7005695
Identifier TypeMEDICAID
Identifier StateRI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: