MEDICARE: SHANTA D SUMLIN

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1780522631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTA D SUMLIN

Provider Business Mailing Address
First Line	:	4720 SALISBURY RD STE 104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6101
Country	:	US
Telephone Number	:	866-932-2777
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 SALISBURY RD STE 104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6101
Country	:	US
Telephone Number	:	866-932-2777
Fax Number	:

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ SHANTA D SUMLIN ” Practice Location

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