Healthcare Provider Details

I. General information

NPI: 1093506602
Provider Name (Legal Business Name): SUMARI OMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 17TH ST APT C
SARASOTA FL
34234-7520
US

IV. Provider business mailing address

1945 17TH ST APT C
SARASOTA FL
34234-7520
US

V. Phone/Fax

Practice location:
  • Phone: 941-210-0384
  • Fax: 941-210-0783
Mailing address:
  • Phone: 941-210-0384
  • Fax: 941-210-0783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1497
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: