Provider Demographics
NPI:1649428152
Name:SDRULLA, EVELYN ALICE (PA-C)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:ALICE
Last Name:SDRULLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6081 S. QUEBEC
Mailing Address - Street 2:STE 200
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-721-7330
Mailing Address - Fax:720-488-6566
Practice Address - Street 1:6081 S. QUEBEC
Practice Address - Street 2:STE 200
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-721-7330
Practice Address - Fax:720-488-6566
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA1578363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical