MEDICARE: SOPHIA MARIE PATRIKIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	002774	NY

General Provider Information

NPI Number	:	1386155372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA MARIE PATRIKIS

Provider Business Mailing Address
First Line	:	7 JAMES DR
Second Line	:
City	:	NANUET
State	:	NY
Zip	:	10954-1908
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 MEDICAL PARK DR STE 205
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-3560
Country	:	US
Telephone Number	:	845-362-1350
Fax Number	:	845-362-1350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2017
Last Update Date	:	10/17/2017

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Directions to “ SOPHIA MARIE PATRIKIS ” Practice Location

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