Provider Demographics
NPI:1225646722
Name:WEDGE, SUMYYAH
Entity Type:Individual
Prefix:
First Name:SUMYYAH
Middle Name:
Last Name:WEDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 TAYLOR ST NE APT 34H
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-4339
Mailing Address - Country:US
Mailing Address - Phone:202-247-0054
Mailing Address - Fax:
Practice Address - Street 1:20 CHESAPEAKE ST SE APT 5
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2807
Practice Address - Country:US
Practice Address - Phone:202-506-5359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant