Provider Demographics
NPI:1750260592
Name:SHUMWAY, HOLLY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SHUMWAY
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 1:1213 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2129
Mailing Address - Country:US
Mailing Address - Phone:928-965-2400
Mailing Address - Fax:928-965-2400
Practice Address - Street 1:1213 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2129
Practice Address - Country:US
Practice Address - Phone:928-965-2400
Practice Address - Fax:928-965-2400
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist