Healthcare Provider Details

I. General information

NPI: 1497581656
Provider Name (Legal Business Name): SOPHIA M HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LITTLE PLAINS RD
HUNTINGTON NY
11743-4550
US

IV. Provider business mailing address

25 LITTLE PLAINS RD
HUNTINGTON NY
11743-4550
US

V. Phone/Fax

Practice location:
  • Phone: 631-266-4489
  • Fax:
Mailing address:
  • Phone: 631-266-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1840680241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: