Healthcare Provider Details

I. General information

NPI: 1336268614
Provider Name (Legal Business Name): NASRIN SOROCK SISK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 COVE TOWER DR APT 201
NAPLES FL
34110-6087
US

IV. Provider business mailing address

920 VARNUM ST NE
WASHINGTON DC
20017-2145
US

V. Phone/Fax

Practice location:
  • Phone: 240-644-7551
  • Fax:
Mailing address:
  • Phone: 202-269-7430
  • Fax: 202-269-7328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME152188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: