Provider Demographics
NPI:1265409031
Name:SHUMAN, PAMELA L (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:SHUMAN
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 1:189 STORRS RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1683
Mailing Address - Country:US
Mailing Address - Phone:860-456-1311
Mailing Address - Fax:860-423-6114
Practice Address - Street 1:934 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-1405
Practice Address - Country:US
Practice Address - Phone:860-779-2101
Practice Address - Fax:860-779-3807
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0479552084P0804X
RI91442084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7005695Medicaid
RI7005695Medicaid
RI7005695Medicaid