Healthcare Provider Details

I. General information

NPI: 1407327737
Provider Name (Legal Business Name): CAROLINE SUTTLE PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BARCLAY RD
NEWPORT NEWS VA
23606-1465
US

IV. Provider business mailing address

185 E 85TH ST APT 11A
NEW YORK NY
10028-2165
US

V. Phone/Fax

Practice location:
  • Phone: 757-236-3945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023243
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: