Provider Demographics
NPI:1417763012
Name:SUMTER, ADRIONNA SHABRILLE
Entity type:Individual
Prefix:
First Name:ADRIONNA
Middle Name:SHABRILLE
Last Name:SUMTER
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 1:1029 RABON POND DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5866
Mailing Address - Country:US
Mailing Address - Phone:803-614-5314
Mailing Address - Fax:
Practice Address - Street 1:1029 RABON POND DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5866
Practice Address - Country:US
Practice Address - Phone:803-614-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF11240552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily