Provider Demographics
NPI:1437662871
Name:SUDZINA, NICHOLAS ALAN (PA-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALAN
Last Name:SUDZINA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 KNOLLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1324
Mailing Address - Country:US
Mailing Address - Phone:330-980-8649
Mailing Address - Fax:
Practice Address - Street 1:3975 EMBASSY PKWY STE 102
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8335
Practice Address - Country:US
Practice Address - Phone:330-668-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005329RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant