MEDICARE: DR. TERESA JEAN SHUMWAY AU.D., CCC-A, FAAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	3950	SC
2	231H00000X	Audiologist	999-1	NY

General Provider Information

NPI Number	:	1366579930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA JEAN SHUMWAY AU.D., CCC-A, FAAA

Provider Business Mailing Address
First Line	:	3885 RENEE DR
Second Line	:	SUITE 102
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4372
Country	:	US
Telephone Number	:	843-903-0635
Fax Number	:	843-903-0636

Provider Business Practice Location Address
First Line	:	3885 RENEE DR
Second Line	:	SUITE 102
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4372
Country	:	US
Telephone Number	:	843-903-0635
Fax Number	:	843-903-0636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	01/12/2012

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