Provider Demographics
NPI:1235452574
Name:SLANDA, SUMMER R (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:R
Last Name:SLANDA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:SUMMER
Other - Middle Name:R
Other - Last Name:BRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1613 N HARRISON PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:320 POMFRET STREET
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260
Practice Address - Country:US
Practice Address - Phone:860-928-6541
Practice Address - Fax:954-851-1746
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN247160367500000X
CT12.006455367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered