Provider Demographics
NPI:1801143466
Name:SUNSERI, PAUL ANTHONY (PSYD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:SUNSERI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 MEESHA LN
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-7740
Mailing Address - Country:US
Mailing Address - Phone:530-402-8540
Mailing Address - Fax:
Practice Address - Street 1:5000 WINDPLAY DR
Practice Address - Street 2:STE. 2
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9365
Practice Address - Country:US
Practice Address - Phone:530-647-6458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25191103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical