MEDICARE: SHINUMOL SABU APRN

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	363LF0000X	Family Nurse Practitioner	11001435	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518425131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHINUMOL SABU APRN

Provider Business Mailing Address
First Line	:	19015 US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6708
Country	:	US
Telephone Number	:	352-383-3484
Fax Number	:	352-735-0517

Provider Business Practice Location Address
First Line	:	19015 US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6708
Country	:	US
Telephone Number	:	352-383-3484
Fax Number	:	352-735-0517

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

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	02/21/2021

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Directions to “ SHINUMOL SABU APRN” Practice Location

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