Provider Demographics
NPI:1134370935
Name:SUMER STATLER AEED, LLC
Entity type:Organization
Organization Name:SUMER STATLER AEED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMER
Authorized Official - Middle Name:STATLER
Authorized Official - Last Name:AEED
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:480-607-1022
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7732
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:7010 E ACOMA DR
Practice Address - Street 2:SUITE A203
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3553
Practice Address - Country:US
Practice Address - Phone:480-607-1022
Practice Address - Fax:480-367-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3443103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78960Medicare PIN
AZZ128089Medicare PIN