Provider Demographics
NPI:1982759973
Name:SHUMSKY, ILANA BETH (MD)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:BETH
Last Name:SHUMSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 N BANTRY PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-1863
Mailing Address - Country:US
Mailing Address - Phone:208-343-2460
Mailing Address - Fax:208-422-1319
Practice Address - Street 1:4620 N BANTRY PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-1863
Practice Address - Country:US
Practice Address - Phone:208-343-2460
Practice Address - Fax:208-422-1319
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7665207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDVAD000Medicare ID - Type Unspecified