Provider Demographics
NPI:1235107020
Name:SUTTLE, EVELYN AMY
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:AMY
Last Name:SUTTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2635
Mailing Address - Country:US
Mailing Address - Phone:336-753-6155
Mailing Address - Fax:336-753-1280
Practice Address - Street 1:161 E LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2635
Practice Address - Country:US
Practice Address - Phone:336-753-6155
Practice Address - Fax:336-753-1280
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26159208000000X
2080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8981055Medicaid
NC2211927Medicare PIN
NC8981055Medicaid