Healthcare Provider Details

I. General information

NPI: 1518878834
Provider Name (Legal Business Name): SUMMIT NP IN PSYCHIATRY HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 E 135TH ST STE 306A
BRONX NY
10454-3408
US

IV. Provider business mailing address

749 E 135TH ST STE 306A
BRONX NY
10454-3408
US

V. Phone/Fax

Practice location:
  • Phone: 716-277-1941
  • Fax: 716-306-6291
Mailing address:
  • Phone: 716-277-1941
  • Fax: 716-306-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AWA NDOW
Title or Position: NP
Credential:
Phone: 719-941-1400