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General NPI Number Information
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NPI Number | 1063356947
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Entity Type | Individual
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Provider Name | SOPHIA RICKETTS
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Gender | Female
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 13802 QUEENS BLVD
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City | JAMAICA
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State | NY
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Zip | 11435-2665
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Country | US
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Telephone | 718-206-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 18340 DUNLOP AVE
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City | SAINT ALBANS
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State | NY
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Zip | 11412-1512
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Country | US
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Telephone | 718-206-2000
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Fax | 718-487-5484
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 270463-01
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License Number State | NY
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