Healthcare Provider Details

I. General information

NPI: 1316864978
Provider Name (Legal Business Name): SOPHIA VASELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E SIX FORKS RD STE 107
RALEIGH NC
27609-7743
US

IV. Provider business mailing address

600 S DUKE ST UNIT 51
DURHAM NC
27701-3588
US

V. Phone/Fax

Practice location:
  • Phone: 919-619-2355
  • Fax:
Mailing address:
  • Phone: 248-535-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30005429
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: