Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1214 | OK |
Y | 103T00000X | Psychologist | 1214 | OK |
NPI | 1013058817 |
---|---|
Provider Name | Miss Sumali M Fernando |
First Address | Oklahoma City, OK 73116-3632 |
Second Address | Oklahoma City, OK 73116-3632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 22/09/2014 |