Healthcare Provider Details

I. General information

NPI: 1366115610
Provider Name (Legal Business Name): SOPHIE WALDMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW STE M4200
WASHINGTON DC
20007-2196
US

IV. Provider business mailing address

79 SHORE DR S
COPIAGUE NY
11726-5323
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8830
  • Fax:
Mailing address:
  • Phone: 516-658-9053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: