MEDICARE: SOPHIA ROSE MILLER

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	406331	NY

General Provider Information

NPI Number	:	1477389807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA ROSE MILLER

Provider Business Mailing Address
First Line	:	330 E 63RD ST APT 5P
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7710
Country	:	US
Telephone Number	:	301-787-7514
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 E 63RD ST APT 5P
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7710
Country	:	US
Telephone Number	:	301-787-7514
Fax Number	:

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

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	09/11/2024

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Directions to “ SOPHIA ROSE MILLER ” Practice Location

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