Individual provider Active NPI

Sumali M Fernando, PSY.D.

  • Psychologist
  • Oklahoma City, OK
National Provider Identifier
1013058817
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1214 Issued in OK
Practice address
3035 NW 63Rd St
Suite 227
Oklahoma City, OK 73116-3632
Phone
(405) 849-6173
Fax
(405) 544-5916
NPI assigned
Feb 12, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1214 OK Primary

Addresses

Primary practice location

3035 NW 63Rd St
Suite 227
Oklahoma City, OK 73116-3632

Mailing address

3035 NW 63Rd St
Suite 227
Oklahoma City, OK 73116-3632
Phone (817) 681-9839

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141223000252 OK Practitioner - Clinical Psychologist 3779806823 Reassigns benefits to 1 organization
Practice locations: Oklahoma City, OK

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3035 NW 63Rd St
Oklahoma City, OK 73116-3631
Phone (405) 242-6460

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1214OKMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sumali Fernando LLC Current Accepting new patients

Locations

3035 NW 63rd St
Ste 227
Oklahoma City, OK 73116
Phone (405) 242-6460

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1013058817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3035 NW 63RD ST",
            "address_2": "SUITE 227",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731163632",
            "telephone_number": "817-681-9839",
            "fax_number": "405-544-5916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3035 NW 63RD ST",
            "address_2": "SUITE 227",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731163632",
            "telephone_number": "405-849-6173",
            "fax_number": "405-544-5916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDO",
        "first_name": "SUMALI",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OK",
            "license": "1214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.