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General NPI Number Information
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NPI Number | 1043084254
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Entity Type | Individual
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Provider Name | MEAGAN SUMNER PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 775 MALABAR RD
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City | MALABAR
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State | FL
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Zip | 32950-3112
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Country | US
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Telephone | 321-241-6800
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Fax | 321-241-6890
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Provider Business Mailing Address
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Address Line | PO BOX 1137
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City | MELBOURNE
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State | FL
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Zip | 32902-1137
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Country | US
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Telephone | 321-952-9696
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9118981
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | NC
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