Healthcare Provider Details

I. General information

NPI: 1770741555
Provider Name (Legal Business Name): SUSANNA SORRENTINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2538 ANTHEM VILLAGE DR STE 110
HENDERSON NV
89052-5551
US

IV. Provider business mailing address

2538 ANTHEM VILLAGE DR STE 110
HENDERSON NV
89052-5551
US

V. Phone/Fax

Practice location:
  • Phone: 702-732-6800
  • Fax: 702-932-9611
Mailing address:
  • Phone: 702-732-6800
  • Fax: 702-932-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number244966
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number18040
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: