Provider Demographics
NPI:1518955673
Name:SHUMEYKO, NANCY E (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:SHUMEYKO
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 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-797-4496
Mailing Address - Fax:607-729-5995
Practice Address - Street 1:4417 VESTAL PARKWAY EAST
Practice Address - Street 2:SUITE 301
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3556
Practice Address - Country:US
Practice Address - Phone:607-797-4496
Practice Address - Fax:607-729-5995
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173940207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01084202Medicaid
NYJ400059277Medicare PIN
E87592Medicare UPIN