Healthcare Provider Details

I. General information

NPI: 1497958706
Provider Name (Legal Business Name): YANA SHUMYATCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 LAKE SHORE BLVD
EUCLID OH
44119-1078
US

IV. Provider business mailing address

18901 LAKE SHORE BLVD
EUCLID OH
44119-1078
US

V. Phone/Fax

Practice location:
  • Phone: 216-692-8644
  • Fax: 216-692-8704
Mailing address:
  • Phone: 216-692-8644
  • Fax: 216-692-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57006732
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35090315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: