Provider Demographics
NPI:1083032833
Name:ZUMWALT, EUGENIA SHEVCHENKO (DO)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:SHEVCHENKO
Last Name:ZUMWALT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MERCED ST STE 315
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4201
Mailing Address - Country:US
Mailing Address - Phone:510-545-3000
Mailing Address - Fax:510-454-3005
Practice Address - Street 1:2500 MERCED ST STE 54
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4201
Practice Address - Country:US
Practice Address - Phone:510-362-5144
Practice Address - Fax:510-454-3005
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty