Provider Demographics
NPI:1982836425
Name:SHUMWAY, ANTHONY ALAN (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ALAN
Last Name:SHUMWAY
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18660 BAGLEY RD BLDG 1
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3483
Mailing Address - Country:US
Mailing Address - Phone:440-234-8746
Mailing Address - Fax:440-234-8748
Practice Address - Street 1:18660 BAGLEY RD BLDG 1
Practice Address - Street 2:SUITE 404
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-234-8746
Practice Address - Fax:440-234-8748
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP10886363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0065524Medicaid
OH0065524Medicaid