MEDICARE: MISBAH SUMAR

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	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1972355642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISBAH SUMAR

Provider Business Mailing Address
First Line	:	4250 W LAKE SAMMAMISH PKWY NE APT E1027
Second Line	:
City	:	REDMOND
State	:	WA
Zip	:	98052-5680
Country	:	US
Telephone Number	:	206-471-0593
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 228TH AVE NE # 931
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7222
Country	:	US
Telephone Number	:	425-428-7517
Fax Number	:

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

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	04/04/2024

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Directions to “ MISBAH SUMAR ” Practice Location

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