Healthcare Provider Details

I. General information

NPI: 1629989157
Provider Name (Legal Business Name): CHELSEA SUMI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COMMERCIAL CENTER DR
RUSKIN FL
33573-6827
US

IV. Provider business mailing address

5727 28TH ST E UNIT 206
ELLENTON FL
34222-7370
US

V. Phone/Fax

Practice location:
  • Phone: 561-516-1575
  • Fax:
Mailing address:
  • Phone: 561-516-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: