MEDICARE: CHANTA SUTTON MS, MHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1053731141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTA SUTTON MS, MHC

Provider Business Mailing Address
First Line	:	4425 E TARPON DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-8323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 N LOIS AVE
Second Line	:	SUITE 27
City	:	TAMPA
State	:	FL
Zip	:	33609-2216
Country	:	US
Telephone Number	:	813-402-8104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	04/16/2014

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