Healthcare Provider Details

I. General information

NPI: 1114019940
Provider Name (Legal Business Name): ELENA S.R. SOROURI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A.I. DUPONT HOSPITAL FOR CHILDREN 1600 ROCKLAND ROAD
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

NEMOURS CHILDRENS CLINIC P.O. BOX 404112
ATLANTA GA
30384-0001
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4000
  • Fax: 302-651-4945
Mailing address:
  • Phone: 904-390-3610
  • Fax: 904-288-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC50000137
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC50000137
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: