MEDICARE: SOFIA NOOR ALI

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	261QA0600X	Adult Day Care Clinic/Center
2	251C00000X	Developmentally Disabled Services Day Training Agency		OH

General Provider Information

NPI Number	:	1396581609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA NOOR ALI

Provider Business Mailing Address
First Line	:	2823 BALLYVAUGHN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-6503
Country	:	US
Telephone Number	:	614-598-5078
Fax Number	:

Provider Business Practice Location Address
First Line	:	2823 BALLYVAUGHN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-6503
Country	:	US
Telephone Number	:	614-598-5078
Fax Number	:

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

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/05/2024

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Directions to “ SOFIA NOOR ALI ” Practice Location

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