Provider Demographics
NPI:1003907262
Name:SHUMATE, EDWARD MICHAEL (PHD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:SHUMATE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:USAMEDDAC WUERZBURG
Mailing Address - Street 2:ATTN CREDENTIALS OFFICE UNIT 26610
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:DE
Mailing Address - Phone:01149931-804-3616
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:USAMEDDAC WUERZBURG
Practice Address - Street 2:DEPT OF BEHAVIORAL HEALTH
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244
Practice Address - Country:DE
Practice Address - Phone:0114998-118-3811
Practice Address - Fax:0114998-118-3854
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA1217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADOOOMedicare UPIN