Provider Demographics
NPI:1215256037
Name:SUMPTER, SIBYL DEANNA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SIBYL
Middle Name:DEANNA
Last Name:SUMPTER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 AUDUBON LAKE DR
Mailing Address - Street 2:UNIT 10C32
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8530
Mailing Address - Country:US
Mailing Address - Phone:919-572-0480
Mailing Address - Fax:919-572-0480
Practice Address - Street 1:115 BARNHILL ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-4028
Practice Address - Country:US
Practice Address - Phone:919-824-7257
Practice Address - Fax:919-572-0480
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7401065Medicaid