Healthcare Provider Details

I. General information

NPI: 1588599104
Provider Name (Legal Business Name): CHELSEA ANN SORAHAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 JERICHO TPKE STE 201
SYOSSET NY
11791-4538
US

IV. Provider business mailing address

20 COTTAGE AVE
BAY SHORE NY
11706-8659
US

V. Phone/Fax

Practice location:
  • Phone: 516-802-4884
  • Fax:
Mailing address:
  • Phone: 516-965-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360122-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: