MEDICARE: DELAYNE SUTTON PLATA M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1215101837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELAYNE SUTTON PLATA M.A.

Provider Business Mailing Address
First Line	:	5400 BIG TYLER RD # D
Second Line	:
City	:	CROSS LANES
State	:	WV
Zip	:	25313-1178
Country	:	US
Telephone Number	:	304-776-6571
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 BIG TYLER RD # D
Second Line	:
City	:	CROSS LANES
State	:	WV
Zip	:	25313-1178
Country	:	US
Telephone Number	:	304-776-6571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2008

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