Provider Demographics
NPI:1831424175
Name:SUTTON, TERESA Y
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:Y
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:PO BOX 2871
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-4009
Mailing Address - Country:US
Mailing Address - Phone:803-920-7744
Mailing Address - Fax:803-407-2957
Practice Address - Street 1:15 BEECH BRANCH CT
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8046
Practice Address - Country:US
Practice Address - Phone:803-920-7744
Practice Address - Fax:803-407-2957
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2009-38960-38100332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies