Healthcare Provider Details

I. General information

NPI: 1447955331
Provider Name (Legal Business Name): SOPRINYE ELIM DAPPA-FOMBO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 SOUTH RD STE 104
POUGHKEEPSIE NY
12601-6843
US

IV. Provider business mailing address

1825 EASTERN PKWY APT 2F
BROOKLYN NY
11233-6905
US

V. Phone/Fax

Practice location:
  • Phone: 470-667-9538
  • Fax:
Mailing address:
  • Phone: 470-667-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: