MEDICARE: SUMAIYAH A MOSS

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	373H00000X	Day Training/Habilitation Specialist
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1639992381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMAIYAH A MOSS

Provider Business Mailing Address
First Line	:	45 E CITY AVE UNIT 643
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2421
Country	:	US
Telephone Number	:	215-485-1609
Fax Number	:

Provider Business Practice Location Address
First Line	:	4442 RIDGE AVE APT 213
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1856
Country	:	US
Telephone Number	:	215-485-1609
Fax Number	:

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

Provider Enumeration Date	:	11/01/2024
Last Update Date	:	11/01/2024

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Directions to “ SUMAIYAH A MOSS ” Practice Location

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