Provider Demographics
NPI:1104264712
Name:SUGIMOTO, YUKI ANNAJEAN
Entity type:Individual
Prefix:
First Name:YUKI
Middle Name:ANNAJEAN
Last Name:SUGIMOTO
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 1:7272 HENRY CLAY BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3582
Mailing Address - Country:US
Mailing Address - Phone:315-243-5270
Mailing Address - Fax:
Practice Address - Street 1:7272 HENRY CLAY BLVD APT 101
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3582
Practice Address - Country:US
Practice Address - Phone:315-243-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20000089112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer