Healthcare Provider Details

I. General information

NPI: 1588536866
Provider Name (Legal Business Name): STEPHANIE SOROKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 CHESTNUT ST
PHILADELPHIA PA
19104-2816
US

IV. Provider business mailing address

2704 E ONTARIO ST
PHILADELPHIA PA
19134-6011
US

V. Phone/Fax

Practice location:
  • Phone: 215-895-2000
  • Fax:
Mailing address:
  • Phone: 215-200-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP033646
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: