Provider Demographics
NPI:1093038069
Name:SUDAR, CHERILYN ANN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERILYN
Middle Name:ANN
Last Name:SUDAR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 TOWNSHIP ROAD 581
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:OH
Mailing Address - Zip Code:44880-9767
Mailing Address - Country:US
Mailing Address - Phone:419-736-3012
Mailing Address - Fax:
Practice Address - Street 1:3050 REGENT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5806
Practice Address - Country:US
Practice Address - Phone:214-689-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09215-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily