Healthcare Provider Details

I. General information

NPI: 1851235972
Provider Name (Legal Business Name): MS. SOPHIA NICOLE CLARKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1854 CEDAR AVE APT 5M
BRONX NY
10453-0467
US

IV. Provider business mailing address

1854 CEDAR AVE APT 5M 5M
BRONX NY
10453-0467
US

V. Phone/Fax

Practice location:
  • Phone: 347-863-1636
  • Fax: 347-863-1636
Mailing address:
  • Phone: 347-863-1636
  • Fax: 347-863-1636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberN07574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: