Healthcare Provider Details

I. General information

NPI: 1326970898
Provider Name (Legal Business Name): MIRANDA SUMSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MOLLYS WAY
POUGHKEEPSIE NY
12601-6304
US

IV. Provider business mailing address

PO BOX 2512
POUGHKEEPSIE NY
12603-8512
US

V. Phone/Fax

Practice location:
  • Phone: 845-689-0910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: