Healthcare Provider Details

I. General information

NPI: 1598030348
Provider Name (Legal Business Name): SOFIA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 BRYANT AVE
BRONX NY
10474-6006
US

IV. Provider business mailing address

730 BRYANT AVE
BRONX NY
10474-6006
US

V. Phone/Fax

Practice location:
  • Phone: 718-542-1537
  • Fax:
Mailing address:
  • Phone: 718-542-1537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number594024-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: