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General NPI Number Information
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NPI Number | 1528579950
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Entity Type | Individual
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Provider Name | JULIA VLADA SHUMKOV PA
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Gender | Female
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 10474 W THUNDERBIRD BLVD STE 200
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City | SUN CITY
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State | AZ
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Zip | 85351-3015
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Country | US
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Telephone | 623-377-7410
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2099
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City | SUN CITY
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State | AZ
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Zip | 85372-2099
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Country | US
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Telephone | 623-377-7410
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Fax | 866-798-8023
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00450400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 7767
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License Number State | AZ
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