Provider Demographics
NPI:1255927653
Name:CONSTANT, SUMMER BENI
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:BENI
Last Name:CONSTANT
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 1:3620 KIRKWOOD HWY # 304
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5104
Mailing Address - Country:US
Mailing Address - Phone:302-525-9865
Mailing Address - Fax:
Practice Address - Street 1:3620 KIRKWOOD HWY # 304
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5104
Practice Address - Country:US
Practice Address - Phone:302-525-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEM1-0101192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty