Provider Demographics
NPI:1548096548
Name:SHUMWAY, ROSS (RDN)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:SHUMWAY
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 N 145TH AVE APT 3029
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-5410
Mailing Address - Country:US
Mailing Address - Phone:978-314-6876
Mailing Address - Fax:
Practice Address - Street 1:1830 N 145TH AVE APT 3029
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-5410
Practice Address - Country:US
Practice Address - Phone:978-314-6876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86076439133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered