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General NPI Number Information
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NPI Number | 1952726168
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Entity Type | Individual
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Provider Name | AYUMI SHIMADA MA, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 5795 LEWISTON RD NIAGARA UNIVERSITY ATHLETICS
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City | NIAGARA UNIVERSITY
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State | NY
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Zip | 14109
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Country | US
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Telephone | 716-286-8622
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Fax | 716-286-8656
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Provider Business Mailing Address
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Address Line | 4875 W EDDY DR APT 218
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City | LEWISTON
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State | NY
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Zip | 14092-2309
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Country | US
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Telephone |
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001970-1
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License Number State | NY
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