Provider Demographics
NPI:1245762350
Name:SHUMWAY, RILEY
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:SHUMWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 GONI RD
Mailing Address - Street 2:D-132
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-8008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3416 GONI RD
Practice Address - Street 2:D-132
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-8008
Practice Address - Country:US
Practice Address - Phone:775-687-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst