Provider Demographics
NPI:1881707503
Name:SHUMAKER, SISAN J
Entity type:Individual
Prefix:MRS
First Name:SISAN
Middle Name:J
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 1:57961 JARRODS SONG RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43718-9404
Mailing Address - Country:US
Mailing Address - Phone:748-484-1210
Mailing Address - Fax:740-484-1210
Practice Address - Street 1:543855 NATIONAL RD
Practice Address - Street 2:STONE HOUSE PLACE APT 7
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912-1566
Practice Address - Country:US
Practice Address - Phone:740-633-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant