Provider Demographics
NPI:1700401148
Name:SUTFIN, CARISSA LEE
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:LEE
Last Name:SUTFIN
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 1:6103 DORA BLVD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-4930
Mailing Address - Country:US
Mailing Address - Phone:330-569-8206
Mailing Address - Fax:
Practice Address - Street 1:6103 DORA BLVD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-4930
Practice Address - Country:US
Practice Address - Phone:330-569-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist