Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0103300920 | VA |
Y | 222Z00000X | Podiatrist | 0103300920 | VA |
N | 213EP1101X | Primary Podiatric Medicine | 0103300920 | VA |
N | 111NR0200X | Radiology | 0103300920 | VA |
N | 213ER0200X | Radiology | 0103300920 | VA |
NPI | 1407829328 |
---|---|
Provider Name | Joanna G Shuman |
First Address | Sterling, VA 20166-6580 |
Second Address | Sterling, VA 20166-6580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 22/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U99056 | (02) |