Healthcare Provider Details

I. General information

NPI: 1316189947
Provider Name (Legal Business Name): SOPHIA L. MCBEAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BARKER AVE 4TH FLOOR
WHITE PLAINS NY
10601-1509
US

IV. Provider business mailing address

3 BARKER AVE 4TH FLOOR
WHITE PLAINS NY
10601-1509
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-1199
  • Fax: 914-949-1245
Mailing address:
  • Phone: 914-949-1199
  • Fax: 914-949-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number505815
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304689
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: