Healthcare Provider Details

I. General information

NPI: 1154958700
Provider Name (Legal Business Name): ROYCE SUMAYO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 JOSEPHS DR
YORKTOWN VA
23693-3405
US

IV. Provider business mailing address

1776 WOODSTEAD CT STE 208
THE WOODLANDS TX
77380-1480
US

V. Phone/Fax

Practice location:
  • Phone: 757-272-0300
  • Fax:
Mailing address:
  • Phone: 877-749-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101283343
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0102208541
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: