Healthcare Provider Details

I. General information

NPI: 1295698611
Provider Name (Legal Business Name): MARIE BLANDINE PAUL SHUMBA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPRINGBROOKE BLVD.
MEDIA PA
19063
US

IV. Provider business mailing address

PO BOX 225
COATESVILLE PA
19320-0225
US

V. Phone/Fax

Practice location:
  • Phone: 215-237-1607
  • Fax:
Mailing address:
  • Phone: 551-242-9583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC001858
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: