Provider Demographics
NPI:1457708802
Name:SHUMBUSHO, DIANE IRAGENA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:IRAGENA
Last Name:SHUMBUSHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:IRAGENA
Other - Last Name:BIZIMANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1575 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9371
Mailing Address - Country:US
Mailing Address - Phone:315-785-4155
Mailing Address - Fax:315-779-5066
Practice Address - Street 1:1575 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9371
Practice Address - Country:US
Practice Address - Phone:315-785-4155
Practice Address - Fax:315-779-5066
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101264178207V00000X
NY328335207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology