Provider Demographics
NPI:1700640745
Name:SHUMAKER, SANDRA RAY
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:RAY
Last Name:SHUMAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 SHUMAKER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:WV
Mailing Address - Zip Code:26440-7479
Mailing Address - Country:US
Mailing Address - Phone:304-265-3507
Mailing Address - Fax:
Practice Address - Street 1:1378 SHUMAKER RIDGE RD
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:WV
Practice Address - Zip Code:26440-7479
Practice Address - Country:US
Practice Address - Phone:304-265-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant