Healthcare Provider Details

I. General information

NPI: 1023672177
Provider Name (Legal Business Name): SHAMON KENTON GUMBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LENOX AVENUE
NEW YORK NY
10037
US

IV. Provider business mailing address

506 LENOX AVENUE
NEW YORK NY
10037
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-1641
  • Fax: 212-939-3536
Mailing address:
  • Phone: 212-939-1641
  • Fax: 212-939-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: