MEDICARE: SOPHIA ROSE MICELI

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1659231355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA ROSE MICELI

Provider Business Mailing Address
First Line	:	560 W 169TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3913
Country	:	US
Telephone Number	:	212-927-0607
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 W 169TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3913
Country	:	US
Telephone Number	:	212-927-0607
Fax Number	:

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

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	11/14/2025

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Directions to “ SOPHIA ROSE MICELI ” Practice Location

Language	Start Address	Practice Location

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