Provider Demographics
NPI:1922212083
Name:SUMNER, BETHANY JAYNE (PA)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:JAYNE
Last Name:SUMNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:JAYNE
Other - Last Name:SUMNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:2920 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756
Mailing Address - Country:US
Mailing Address - Phone:516-735-4048
Mailing Address - Fax:516-785-4530
Practice Address - Street 1:2920 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1402
Practice Address - Country:US
Practice Address - Phone:516-735-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005076363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical