Provider Demographics
NPI:1952009375
Name:SUMMERSKYY TELEHEALTH LLC
Entity Type:Organization
Organization Name:SUMMERSKYY TELEHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:206-929-6200
Mailing Address - Street 1:11700 MUKILTEO SPEEDWAY # 201-4019
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5432
Mailing Address - Country:US
Mailing Address - Phone:206-929-6200
Mailing Address - Fax:
Practice Address - Street 1:600 1ST AVE STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2287
Practice Address - Country:US
Practice Address - Phone:206-929-6200
Practice Address - Fax:206-279-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health