Healthcare Provider Details

I. General information

NPI: 1811964430
Provider Name (Legal Business Name): BARRY ALEC SHUMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 SHAKER RD SUITE 202 ALBANY MEMORIAL PROFESSIONAL BLDG
ALBANY NY
12204-1030
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-434-1283
  • Fax: 518-434-0730
Mailing address:
  • Phone: 518-525-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number199463
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: