Healthcare Provider Details

I. General information

NPI: 1558457150
Provider Name (Legal Business Name): STEPHANIE A SHUMATE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NICHOLASVILLE ROAD
LEXINGTON KY
40503
US

IV. Provider business mailing address

3320 TATES CREEK ROAD SUITE 204
LEXINGTON KY
40502
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-2198
  • Fax:
Mailing address:
  • Phone: 859-268-1030
  • Fax: 859-269-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number02329
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: