Provider Demographics
NPI:1790298495
Name:SHUMAN, HOLLY JEANNE (LICAC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:JEANNE
Last Name:SHUMAN
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:NAHANT
Mailing Address - State:MA
Mailing Address - Zip Code:01908-1113
Mailing Address - Country:US
Mailing Address - Phone:617-943-7076
Mailing Address - Fax:
Practice Address - Street 1:63 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2956
Practice Address - Country:US
Practice Address - Phone:978-740-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist