Healthcare Provider Details

I. General information

NPI: 1649160367
Provider Name (Legal Business Name): SORANY ACOSTA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CROOKED HILL RD
BRENTWOOD NY
11717-1039
US

IV. Provider business mailing address

11711 MYRTLE AVE
RICHMOND HILL NY
11418-1751
US

V. Phone/Fax

Practice location:
  • Phone: 631-231-3232
  • Fax: 631-231-3370
Mailing address:
  • Phone: 718-847-9233
  • Fax: 718-849-9654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number693915-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: