Provider Demographics
NPI:1124611744
Name:SUMAYOD, DONNA BELLA (NP)
Entity type:Individual
Prefix:
First Name:DONNA BELLA
Middle Name:
Last Name:SUMAYOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DONNA BELLA
Other - Middle Name:SUMAYOD
Other - Last Name:MONTERDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3718 W NANCY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-5029
Mailing Address - Country:US
Mailing Address - Phone:954-258-7292
Mailing Address - Fax:
Practice Address - Street 1:2640 W BASELINE RD STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6492
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016564363LF0000X
NV87039363LF0000X
AZ296431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily