MEDICARE: MRS. SISAN J SHUMAKER

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	3747P1801X	Personal Care Attendant		OH

General Provider Information

NPI Number	:	1881707503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SISAN J SHUMAKER

Provider Business Mailing Address
First Line	:	57961 JARRODS SONG RD
Second Line	:
City	:	BELMONT
State	:	OH
Zip	:	43718-9404
Country	:	US
Telephone Number	:	748-484-1210
Fax Number	:	740-484-1210

Provider Business Practice Location Address
First Line	:	543855 NATIONAL RD
Second Line	:	STONE HOUSE PLACE APT 7
City	:	BRIDGEPORT
State	:	OH
Zip	:	43912-1566
Country	:	US
Telephone Number	:	740-633-2624
Fax Number	:

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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