Healthcare Provider Details

I. General information

NPI: 1306531116
Provider Name (Legal Business Name): SOFIA BARRIGA STASCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 UNDERHILL BLVD STE 190
SYOSSET NY
11791-3494
US

IV. Provider business mailing address

90 S BEDFORD RD
MOUNT KISCO NY
10549-3412
US

V. Phone/Fax

Practice location:
  • Phone: 516-210-8840
  • Fax:
Mailing address:
  • Phone: 914-241-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number345551-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: