Provider Demographics
NPI:1629588140
Name:SEKERAK, ANGELA SUZANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUZANNE
Last Name:SEKERAK
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:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-0856
Mailing Address - Country:US
Mailing Address - Phone:440-708-4341
Mailing Address - Fax:
Practice Address - Street 1:2999 MCMACKIN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2330
Practice Address - Country:US
Practice Address - Phone:440-428-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000115605363A00000X
OH50.005314RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant