Healthcare Provider Details

I. General information

NPI: 1225437841
Provider Name (Legal Business Name): ANDRIANA SHUMOVA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 ELMWOOD AVE STE 215
ROCHESTER NY
14620-3426
US

IV. Provider business mailing address

1655 ELMWOOD AVE STE 215
ROCHESTER NY
14620-3426
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-1900
  • Fax:
Mailing address:
  • Phone: 585-442-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number058460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: