Healthcare Provider Details

I. General information

NPI: 1518955673
Provider Name (Legal Business Name): NANCY E SHUMEYKO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 VESTAL PARKWAY EAST SUITE 301
VESTAL NY
13850-3556
US

IV. Provider business mailing address

346 GRAND AVE
JOHNSON CITY NY
13790-2580
US

V. Phone/Fax

Practice location:
  • Phone: 607-797-4496
  • Fax: 607-729-5995
Mailing address:
  • Phone: 607-797-4496
  • Fax: 607-729-5995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number173940
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number173940
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: