Healthcare Provider Details

I. General information

NPI: 1194506121
Provider Name (Legal Business Name): CODY LAMAR SHUMAKER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

1600 S ANDREWS AVE
FT LAUDERDALE FL
33316-2510
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-5403
  • Fax: 954-355-5427
Mailing address:
  • Phone: 954-355-5403
  • Fax: 954-355-5427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number203091
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: