Eden D Shumbulo, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2021084066 Issued in VA

Practice address

5465 N Morgan St Apt 501
Alexandria, VA 22312-3328

Phone

(703) 283-3923

NPI assigned

Oct 11, 2021

Last updated

Oct 11, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alexandria Integrative Health Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Alexandria, VA
  • NPI 1477439404

  Family

  NPD Authorized official
• Ett Transportation LLC

  • Non-emergency Medical Transport (VAN)
  • Alexandria, VA
  • NPI 1679278501
  NPD Authorized official
• All Points North Counseling Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Stafford, VA
  • NPI 1790531937
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1619639333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5465 N MORGAN ST APT 501",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223123328",
            "telephone_number": "703-283-3923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5465 N MORGAN ST APT 501",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223123328",
            "telephone_number": "703-283-3923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUMBULO",
        "first_name": "EDEN",
        "middle_name": "D",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-11",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "2021084066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC",
            "identifier": "2021084066",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Alexandria",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Health information",
            "address_1": "5465 N Morgan St Apt 501",
            "city": "Alexandria",
            "state": "VA",
            "country_code": "US",
            "postal_code": "223123328",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Alexandria",
            "affiliation": "N",
            "address_1": "5465 N Morgan St Apt 501",
            "city": "Alexandria",
            "state": "VA",
            "country_code": "US",
            "postal_code": "223123328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Shotlander, LCSW
• Shuaib Medical Center
• Ryan S. Shugarman, M.D.
• Emily Joann Shumaker, NP
• Ryan P Shumate, PT, DPT
• Mona A Shums, PA-C
• Michael Joel Shuster, M.D.
• Daniyal Siddiqi, MD
• Erum Siddiqui
• Talha Siddiqui, M.D.

• Family Nurse Practitioner in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.