Healthcare Provider Details

I. General information

NPI: 1487767257
Provider Name (Legal Business Name): SHERRY SHUMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL SUITE 14A
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-8778
  • Fax: 314-454-5298
Mailing address:
  • Phone: 314-454-8778
  • Fax: 314-454-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberR4E47
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: