Provider Demographics
NPI:1508062712
Name:KUDELKO, SARAH J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:J
Last Name:KUDELKO
Suffix:
Gender:F
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 1:3968 NEW CASTLE RD
Mailing Address - Street 2:2
Mailing Address - City:PULASKI
Mailing Address - State:PA
Mailing Address - Zip Code:16143-1231
Mailing Address - Country:US
Mailing Address - Phone:724-528-1939
Mailing Address - Fax:
Practice Address - Street 1:987 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4222
Practice Address - Country:US
Practice Address - Phone:330-965-8760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002330363A00000X
PAMA052535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant