Healthcare Provider Details

I. General information

NPI: 1104575984
Provider Name (Legal Business Name): SOPHIE TREDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JUNE ST
SANFORD ME
04073-2621
US

IV. Provider business mailing address

25 JUNE ST
SANFORD ME
04073-2621
US

V. Phone/Fax

Practice location:
  • Phone: 207-490-7836
  • Fax: 207-490-7390
Mailing address:
  • Phone: 207-490-7836
  • Fax: 207-490-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD29668
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: