Provider Demographics
NPI:1467055251
Name:SUMRADA, RICHARD C
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:SUMRADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38821 GARDENSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7905
Mailing Address - Country:US
Mailing Address - Phone:440-525-1272
Mailing Address - Fax:
Practice Address - Street 1:38821 GARDENSIDE DR
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7905
Practice Address - Country:US
Practice Address - Phone:440-525-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant