MEDICARE: MS. SOPHIA M BEYENE

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	164W00000X	Licensed Practical Nurse	287689	NY

General Provider Information

NPI Number	:	1427645373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SOPHIA M BEYENE

Provider Business Mailing Address
First Line	:	233 TOWNSEND ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2339
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 TOWNSEND ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2339
Country	:	US
Telephone Number	:	585-509-6994
Fax Number	:

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

Provider Enumeration Date	:	12/27/2020
Last Update Date	:	12/27/2020

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