Healthcare Provider Details

I. General information

NPI: 1467972166
Provider Name (Legal Business Name): SOPHIA AKOSUA BAMPOH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CLEVELAND CLINIC BOULEVARD
WESTON FL
33331
US

IV. Provider business mailing address

214 VILLAGE AT VANDERBILT
NASHVILLE TN
37212-3104
US

V. Phone/Fax

Practice location:
  • Phone: 877-463-2010
  • Fax:
Mailing address:
  • Phone: 413-387-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME153001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: