Provider Demographics
NPI:1376581488
Name:SHUMAKER, ROBERT G (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:SHUMAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5830
Mailing Address - Country:US
Mailing Address - Phone:561-496-0333
Mailing Address - Fax:561-998-4886
Practice Address - Street 1:4455 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-5830
Practice Address - Country:US
Practice Address - Phone:561-496-0333
Practice Address - Fax:561-998-4886
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003610103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59630BMedicare ID - Type Unspecified