Healthcare Provider Details

I. General information

NPI: 1659014017
Provider Name (Legal Business Name): JOHN NICHOLAS JUNG SHUMATE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 DEVONSHIRE ST STE 502
BOSTON MA
02110-1407
US

IV. Provider business mailing address

185 DEVONSHIRE ST STE 502
BOSTON MA
02110-1407
US

V. Phone/Fax

Practice location:
  • Phone: 508-318-8102
  • Fax: 617-219-3097
Mailing address:
  • Phone: 508-318-8102
  • Fax: 617-219-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1025767
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number293493
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: