MEDICARE: DAVID SUMO CEO

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1609402320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SUMO CEO

Provider Business Mailing Address
First Line	:	2501 S CARROLL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-2112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 S CARROLL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-2112
Country	:	US
Telephone Number	:	267-634-6410
Fax Number	:

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

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	03/13/2020

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Directions to “ DAVID SUMO CEO” Practice Location

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