Provider Demographics
NPI:1871070425
Name:SHUM ALFONSO, RAISA (ARNP)
Entity type:Individual
Prefix:PROF
First Name:RAISA
Middle Name:
Last Name:SHUM ALFONSO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 NW 6TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3728
Mailing Address - Country:US
Mailing Address - Phone:786-443-9246
Mailing Address - Fax:
Practice Address - Street 1:952 NW 6TH ST APT 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-3728
Practice Address - Country:US
Practice Address - Phone:786-443-9246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9371480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily