Healthcare Provider Details

I. General information

NPI: 1396649729
Provider Name (Legal Business Name): SOPHIA MAREK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 COLCHESTER AVE
BURLINGTON VT
05401-1417
US

IV. Provider business mailing address

193 CATKIN DR
SOUTH BURLINGTON VT
05403-3003
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1693
  • Fax:
Mailing address:
  • Phone: 802-238-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: