Healthcare Provider Details

I. General information

NPI: 1003346545
Provider Name (Legal Business Name): CLAY BRYANT SHUMWAY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CLINT MOORE RD
BOCA RATON FL
33496-2658
US

IV. Provider business mailing address

20642 N 16TH PL
PHOENIX AZ
85024-4355
US

V. Phone/Fax

Practice location:
  • Phone: 407-960-1717
  • Fax:
Mailing address:
  • Phone: 215-990-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD-001126
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number11926746-0501
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: