Provider Demographics
NPI:1114487899
Name:ABUSRUR, SAMMY SADI (MD)
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:SADI
Last Name:ABUSRUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 S JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7939
Mailing Address - Country:US
Mailing Address - Phone:407-583-7679
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTH PROSPECT ST
Practice Address - Street 2:ARNOLD 3 CHILD PSYCHIATRY
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.00170552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry