Individual
AMY D SUSTAITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
815 S WASHINGTON AVE STE 100, MARSHALL, TX 75670-5316
(903) 927-6800
Mailing address
304 MEDIC LN, STE B, ALVIN, TX 77511-5894
(281) 331-2062
(281) 331-8070
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA07123
TX
363A00000X
Physician Assistant
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420661701
—
TX
Enumeration date
02/16/2011
Last updated
04/16/2021
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