Provider Demographics
NPI:1528579950
Name:SHUMKOV, JULIA VLADA (PA)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:VLADA
Last Name:SHUMKOV
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2099
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85372-2099
Mailing Address - Country:US
Mailing Address - Phone:623-377-7410
Mailing Address - Fax:866-798-8023
Practice Address - Street 1:10474 W THUNDERBIRD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3015
Practice Address - Country:US
Practice Address - Phone:623-377-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00450400363AM0700X
AZ7767363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ$$$$$$$$$OtherSOCIAL SECURITY