MEDICARE: BRETT SHUMWAY

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	103T00000X	Psychologist	10042018-2501	UT

General Provider Information

NPI Number	:	1417483603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT SHUMWAY

Provider Business Mailing Address
First Line	:	996 CEDAR KNLS W
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-3631
Country	:	US
Telephone Number	:	435-327-0176
Fax Number	:

Provider Business Practice Location Address
First Line	:	646 S MAIN ST # 207
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-3549
Country	:	US
Telephone Number	:	435-327-0176
Fax Number	:

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

Provider Enumeration Date	:	05/07/2017
Last Update Date	:	05/07/2017

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Directions to “ BRETT SHUMWAY ” Practice Location

Language	Start Address	Practice Location

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