MEDICARE: MARY MASON SHUMAN

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	363L00000X	Nurse Practitioner	31370	SC
2	363LW0102X	Women's Health Nurse Practitioner	31370	SC

General Provider Information

NPI Number	:	1407453699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MASON SHUMAN

Provider Business Mailing Address
First Line	:	PO BOX 604408
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-4408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 HOSPITAL DR STE 370
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-5293
Country	:	US
Telephone Number	:	843-883-1007
Fax Number	:	843-883-1016

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

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	05/26/2026

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Directions to “ MARY MASON SHUMAN ” Practice Location

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