Provider Demographics
NPI:1497958706
Name:SHUMYATCHER, YANA (MD)
Entity Type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:SHUMYATCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18901 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1078
Mailing Address - Country:US
Mailing Address - Phone:216-692-8644
Mailing Address - Fax:216-692-8704
Practice Address - Street 1:18901 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1078
Practice Address - Country:US
Practice Address - Phone:216-692-8644
Practice Address - Fax:216-692-8704
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57006732208000000X
OH35090315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics