Provider Demographics
NPI:1427321173
Name:DUDEK, AUDREY F (PA-C)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:F
Last Name:DUDEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:F
Other - Last Name:INDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4755 OGLETOWN STANTON RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-2438
Mailing Address - Fax:302-733-4832
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 2670
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-2438
Practice Address - Fax:302-733-4832
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055407363A00000X
C5-0000997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant