Healthcare Provider Details

I. General information

NPI: 1124245865
Provider Name (Legal Business Name): JANELLE ADENIKA SHUMATE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 OBERLIN RD STE 204
RALEIGH NC
27605-1397
US

IV. Provider business mailing address

505 OBERLIN RD STE 204
RALEIGH NC
27605-1397
US

V. Phone/Fax

Practice location:
  • Phone: 919-828-0035
  • Fax: 919-828-0355
Mailing address:
  • Phone: 919-828-0035
  • Fax: 919-828-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200901229
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: