Provider Demographics
NPI:1881939106
Name:SUMNER, MILES DUSTIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:MILES
Middle Name:DUSTIN
Last Name:SUMNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3761 COLIN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-3601
Mailing Address - Country:US
Mailing Address - Phone:716-491-9426
Mailing Address - Fax:
Practice Address - Street 1:3332 WALDEN AVE STE 110
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-2400
Practice Address - Country:US
Practice Address - Phone:716-668-7051
Practice Address - Fax:716-668-7069
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016411-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant