Provider Demographics
NPI:1952726168
Name:SHIMADA, AYUMI (MA, ATC)
Entity Type:Individual
Prefix:
First Name:AYUMI
Middle Name:
Last Name:SHIMADA
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4875 W EDDY DR APT 218
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5795 LEWISTON RD
Practice Address - Street 2:NIAGARA UNIVERSITY ATHLETICS
Practice Address - City:NIAGARA UNIVERSITY
Practice Address - State:NY
Practice Address - Zip Code:14109
Practice Address - Country:US
Practice Address - Phone:716-286-8622
Practice Address - Fax:716-286-8656
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001970-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer