Healthcare Provider Details

I. General information

NPI: 1700799517
Provider Name (Legal Business Name): SOPHIA MARIE KORDAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CHILDRENS WAY
JACKSONVILLE FL
32207-8426
US

IV. Provider business mailing address

2231 CONNELL TER
LYSANDER NY
13027-1030
US

V. Phone/Fax

Practice location:
  • Phone: 904-697-3600
  • Fax:
Mailing address:
  • Phone: 315-350-7103
  • 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: