Healthcare Provider Details

I. General information

NPI: 1407567902
Provider Name (Legal Business Name): SUMMER DOREEMONET MASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 08/03/2026
Certification Date: 01/09/2023
Deactivation Date: 01/09/2023
Reactivation Date: 08/03/2026

III. Provider practice location address

1303 6TH ST NE
CANTON OH
44704-1605
US

IV. Provider business mailing address

1303 6TH ST NE
CANTON OH
44704-1605
US

V. Phone/Fax

Practice location:
  • Phone: 330-268-0260
  • Fax:
Mailing address:
  • Phone: 330-268-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: