Provider Demographics
NPI:1669476065
Name:CUMM, SHAUN (PA)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:CUMM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALNG
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:6 HEARTS WAY
Practice Address - Street 2:ADIRONDACK CARDIOLOGY
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5925
Practice Address - Country:US
Practice Address - Phone:518-792-1233
Practice Address - Fax:518-792-6854
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010236363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02626180Medicaid
NY02626180Medicaid
NYJ400060074Medicare PIN