Provider Demographics
NPI:1093977464
Name:SHUMATE, CASSANDRA B
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:B
Last Name:SHUMATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13794 51ST PL N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8162
Mailing Address - Country:US
Mailing Address - Phone:561-798-3046
Mailing Address - Fax:561-798-3046
Practice Address - Street 1:13794 51ST PL N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8162
Practice Address - Country:US
Practice Address - Phone:561-798-3046
Practice Address - Fax:561-798-3046
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230421000Medicaid