Healthcare Provider Details

I. General information

NPI: 1134040330
Provider Name (Legal Business Name): SOFIA ELIZABETH GALLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 GRANT LINE RD
NEW ALBANY IN
47150-4053
US

IV. Provider business mailing address

3109 WYNBROOKE CIR
LOUISVILLE KY
40241-3122
US

V. Phone/Fax

Practice location:
  • Phone: 502-888-1988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: