Healthcare Provider Details

I. General information

NPI: 1174071401
Provider Name (Legal Business Name): SOFYA SIGALOV PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 LAGUARDIA PL LOWR LEVEL
NEW YORK NY
10012-1402
US

IV. Provider business mailing address

555 LAGUARDIA PL LOWR LEVEL
NEW YORK NY
10012-1402
US

V. Phone/Fax

Practice location:
  • Phone: 212-460-5622
  • Fax: 212-533-8850
Mailing address:
  • Phone: 212-460-5622
  • Fax: 212-533-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00733300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114661
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTMA053097
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023482
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: