Individual
SHAWN RAPHAEL GUMBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
259 1ST ST, MINEOLA, NY 11501-3957
(347) 385-9028
(718) 528-0611
Mailing address
23502 118TH AVE APT 2, CAMBRIA HEIGHTS, NY 11411-1816
(347) 385-9028
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
584827-1
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
121631
NY
Other
Enumeration date
01/18/2018
Last updated
03/07/2018
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