MEDICARE: MANDY SUZANNE ELLER SHUMATE FNP

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	5018407	NC

General Provider Information

NPI Number	:	1467130831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY SUZANNE ELLER SHUMATE FNP

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	336-651-2980
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 W PARK DR
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3564
Country	:	US
Telephone Number	:	336-651-2980
Fax Number	:

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

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	01/20/2026

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