Provider Demographics
NPI:1245948124
Name:SHUMPERT, SHARON (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SHUMPERT
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 DOYLE ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4797
Mailing Address - Country:US
Mailing Address - Phone:803-747-7498
Mailing Address - Fax:803-857-8236
Practice Address - Street 1:1117 DOYLE ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4797
Practice Address - Country:US
Practice Address - Phone:803-747-7498
Practice Address - Fax:803-857-8236
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care