Healthcare Provider Details

I. General information

NPI: 1356204697
Provider Name (Legal Business Name): EMMA CLARE SUTOVICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JANEWAY TOWER-MEDICAL CENTER BLVD 7TH FLOOR
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

JANEWAY TOWER-MEDICAL CENTER BLVD 7TH FLOOR
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2700
  • Fax: 336-716-3825
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-15850
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: