Healthcare Provider Details

I. General information

NPI: 1891608758
Provider Name (Legal Business Name): NEMATOU SORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443E162 1002
BRONX NY
10451
US

IV. Provider business mailing address

443 E 162ND ST APT 1002
BRONX NY
10451-5469
US

V. Phone/Fax

Practice location:
  • Phone: 347-544-5820
  • Fax:
Mailing address:
  • Phone: 347-544-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: