Provider Demographics
NPI:1194002006
Name:COLABUNO, ADRIENNE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:MARIE
Last Name:COLABUNO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ADRIENNE
Other - Middle Name:MARIE
Other - Last Name:SEKERAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9485 MENTOR AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8723
Mailing Address - Country:US
Mailing Address - Phone:216-598-0754
Mailing Address - Fax:
Practice Address - Street 1:9485 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4597
Practice Address - Country:US
Practice Address - Phone:440-205-5716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-05
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant