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NPI Code Detail

MEDICARE: MRS. SARAH J KUDELKO PA-C

MEDICARE: MRS. SARAH J KUDELKO PA-C
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
1363A00000XPhysician Assistant50.002330OH
2363A00000XPhysician AssistantMA052535PA

General Provider Information

NPI Number : 1508062712
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SARAH J KUDELKO PA-C
Provider Business Mailing Address
First Line : 3968 NEW CASTLE RD
Second Line : 2
City : PULASKI
State : PA
Zip : 16143-1231
Country : US
Telephone Number : 724-528-1939
Fax Number :
Provider Business Practice Location Address
First Line : 987 BOARDMAN CANFIELD RD
Second Line :
City : BOARDMAN
State : OH
Zip : 44512-4222
Country : US
Telephone Number : 330-965-8760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2007
Last Update Date : 04/03/2009

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