Healthcare Provider Details

I. General information

NPI: 1134370935
Provider Name (Legal Business Name): SUMER STATLER AEED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 E ACOMA DR SUITE A203
SCOTTSDALE AZ
85254-3553
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-1022
  • Fax: 480-367-1160
Mailing address:
  • Phone: 209-956-7732
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3443
License Number StateAZ

VIII. Authorized Official

Name: SUMER STATLER AEED
Title or Position: OWNER
Credential: EDD
Phone: 480-607-1022