MEDICARE: ASHLEY MABEL SORTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1104541721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MABEL SORTO

Provider Business Mailing Address
First Line	:	8347 VERONA DR
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-3419
Country	:	US
Telephone Number	:	240-762-8870
Fax Number	:

Provider Business Practice Location Address
First Line	:	8347 VERONA DR
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-3419
Country	:	US
Telephone Number	:	240-762-8870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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Directions to “ ASHLEY MABEL SORTO ” Practice Location

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