Healthcare Provider Details

I. General information

NPI: 1467397570
Provider Name (Legal Business Name): SORRENTINA V AWALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E RED BRIDGE RD
KANSAS CITY MO
64131-4035
US

IV. Provider business mailing address

6515 PINE BLUFF BLVD APT 107
KNOXVILLE TN
37909-1687
US

V. Phone/Fax

Practice location:
  • Phone: 816-509-6694
  • Fax:
Mailing address:
  • Phone: 402-277-3921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2025045327
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: