Healthcare Provider Details

I. General information

NPI: 1144739459
Provider Name (Legal Business Name): SHAYE SUMNER AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST
CLEVELAND OH
44113-3108
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-3997
US

V. Phone/Fax

Practice location:
  • Phone: 207-460-1882
  • Fax:
Mailing address:
  • Phone: 207-460-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number021818
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number021818
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number021818
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: