Healthcare Provider Details

I. General information

NPI: 1528988003
Provider Name (Legal Business Name): SOPHIA ROSE DAHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 47TH AVE
LONG ISLAND CITY NY
11101-5416
US

IV. Provider business mailing address

456 AUDRAINE DR
GLENDALE CA
91202-1103
US

V. Phone/Fax

Practice location:
  • Phone: 212-385-3700
  • Fax:
Mailing address:
  • Phone: 818-207-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: