Provider Demographics
NPI:1205427192
Name:SUTTON, ABBEY
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:SUTTON
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 1:1221 CEDAR VALLEY DR APT F
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-1282
Mailing Address - Country:US
Mailing Address - Phone:636-208-6790
Mailing Address - Fax:
Practice Address - Street 1:1221 CEDAR VALLEY DR APT E
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-1282
Practice Address - Country:US
Practice Address - Phone:636-215-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor