MEDICARE: IDESHIA LA'VEEN MARIE SHUMAKER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171W00000X	Contractor
2	251S00000X	Community/Behavioral Health Agency
3	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1649117094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDESHIA LA'VEEN MARIE SHUMAKER

Provider Business Mailing Address
First Line	:	903 NORWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-2050
Country	:	US
Telephone Number	:	419-508-6372
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 NORWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-2050
Country	:	US
Telephone Number	:	419-508-6372
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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