MEDICARE: ELLEN JORDAN SOMMERDORF PA-C, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		TX

General Provider Information

NPI Number	:	1205783057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN JORDAN SOMMERDORF PA-C, RD

Provider Business Mailing Address
First Line	:	201 SETON PKWY
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-8000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SETON PKWY
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-8000
Country	:	US
Telephone Number	:	512-324-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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