Healthcare Provider Details

I. General information

NPI: 1629488168
Provider Name (Legal Business Name): SOPHIA WORTH F.N.P., BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S HIGHLAND AVE
OSSINING NY
10562-4811
US

IV. Provider business mailing address

165 MAIN ST
OSSINING NY
10562-4702
US

V. Phone/Fax

Practice location:
  • Phone: 914-923-4740
  • Fax:
Mailing address:
  • Phone: 914-941-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number574861
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338644-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: