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General NPI Number Information
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NPI Number | 1750370110
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Entity Type | Individual
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Provider Name | MYRIAM MONDESTIN SORRENTINO MD
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Gender | Female
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 3700 WASHINGTON AVE # 1100
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City | EVANSVILLE
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State | IN
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Zip | 47714-0541
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Country | US
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Telephone | 812-485-1894
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Fax | 812-485-1870
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Provider Business Mailing Address
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Address Line | 213 MATCHAPONIX AVE
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City | MONROE
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State | NJ
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Zip | 08831-4080
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Country | US
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Telephone | 732-521-3617
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Fax |
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | MD448921
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | MD448921
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA06923000
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 25MA06923000
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 01095225A
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License Number State | IN
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