Healthcare Provider Details

I. General information

NPI: 1215610415
Provider Name (Legal Business Name): JANA SHUMATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CONGRESS ST
QUINCY MA
02169-0908
US

IV. Provider business mailing address

500 CONGRESS ST
QUINCY MA
02169-0908
US

V. Phone/Fax

Practice location:
  • Phone: 508-524-0497
  • Fax:
Mailing address:
  • Phone: 617-376-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN270635
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN270635
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: