Provider Demographics
NPI:1851727549
Name:SUDBAY, CAROLINE H (PA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:H
Last Name:SUDBAY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:6945 TUTT BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3566
Mailing Address - Country:US
Mailing Address - Phone:719-380-7325
Mailing Address - Fax:719-354-2212
Practice Address - Street 1:421 S TEJON ST STE 250
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2139
Practice Address - Country:US
Practice Address - Phone:719-623-3068
Practice Address - Fax:719-354-2212
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2022-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO3802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant