Healthcare Provider Details

I. General information

NPI: 1932011368
Provider Name (Legal Business Name): SOPHIA GUIDA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 IRVING AVE
SYRACUSE NY
13210-2716
US

IV. Provider business mailing address

115 DUERR RD
LIVERPOOL NY
13090-3703
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-4400
  • Fax:
Mailing address:
  • Phone: 310-430-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86067441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: