Healthcare Provider Details

I. General information

NPI: 1043176357
Provider Name (Legal Business Name): SOFIA GAMBINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1984 S 16TH ST STE 1
WILMINGTON NC
28401-6674
US

IV. Provider business mailing address

PO BOX 15109
WILMINGTON NC
28408-5109
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-8633
  • Fax:
Mailing address:
  • Phone: 910-392-2525
  • 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: