=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649160367
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SORANY ACOSTA REGISTERED NURSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2025
-----------------------------------------------------
Last Update Date | 07/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 CROOKED HILL RD
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11717-1039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-231-3232
-----------------------------------------------------
Fax | 631-231-3370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11711 MYRTLE AVE
-----------------------------------------------------
City | RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11418-1751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-847-9233
-----------------------------------------------------
Fax | 718-849-9654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 693915-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------