Provider Demographics
NPI:1558124867
Name:SULT, ADRIANA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:SULT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 CANOGA AVE STE 1500
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2517
Mailing Address - Country:US
Mailing Address - Phone:747-746-4720
Mailing Address - Fax:747-204-3104
Practice Address - Street 1:6320 CANOGA AVE STE 1500
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2517
Practice Address - Country:US
Practice Address - Phone:747-746-4720
Practice Address - Fax:747-204-3104
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95028901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty