Provider Demographics
NPI:1861839805
Name:SUMRALL, AMANDA J (MS,-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:J
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:MS,-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 PYRAMID WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-5059
Mailing Address - Country:US
Mailing Address - Phone:775-336-0211
Mailing Address - Fax:775-336-0213
Practice Address - Street 1:634 PYRAMID WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431
Practice Address - Country:US
Practice Address - Phone:775-336-0211
Practice Address - Fax:775-336-0213
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT235Z00000X
UT8624516-4102235Z00000X
NVSP-1364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000086096Medicare PIN