Provider Demographics
NPI:1063751766
Name:CIAO, SUMMER (LMT)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:CIAO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:SUMMER
Other - Middle Name:
Other - Last Name:MOURGIDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:76 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-4643
Mailing Address - Country:US
Mailing Address - Phone:585-750-4927
Mailing Address - Fax:
Practice Address - Street 1:76 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-4643
Practice Address - Country:US
Practice Address - Phone:585-750-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018732-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist