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General NPI Number Information
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NPI Number | 1083484943
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Entity Type | Organization
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Legal Business Name | SOR FAMILY HEALTH NURSE PRACTITIONER
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 165 N VILLAGE AVE STE 9
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-3701
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Country | US
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Telephone | 516-682-2350
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Fax | 949-695-2245
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Provider Business Mailing Address
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Address Line | 71 E SEAMAN AVE
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City | FREEPORT
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State | NY
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Zip | 11520-1643
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Country | US
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Telephone | 516-682-2350
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Fax | 949-695-2245
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Authorized Official
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Title or Position | OWNER
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Name | SHAKIRAYE ROOKWOOD
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Credential |
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Telephone | 718-360-3214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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