Basic Information
| Provider Information | |||||||||
| NPI: | 1205259405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUFFOLETTO | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 COPELAND MILL RD | ||||||||
| Address2: | SUITE 1D | ||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147940481 | ||||||||
| FaxNumber: | 6147943711 | ||||||||
| Practice Location | |||||||||
| Address1: | 10330 SAWMILL PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | POWELL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430657790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147940481 | ||||||||
| FaxNumber: | 6147943711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2014 | ||||||||
| LastUpdateDate: | 04/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.