Provider Demographics
NPI:1972799419
Name:SUDIK, KERRI M (PA-C)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:M
Last Name:SUDIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:M
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5700 COOPER FOSTER PARK RD W
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4140
Mailing Address - Country:US
Mailing Address - Phone:440-204-7400
Mailing Address - Fax:440-204-7401
Practice Address - Street 1:5700 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4140
Practice Address - Country:US
Practice Address - Phone:440-204-7373
Practice Address - Fax:440-204-7379
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant