Provider Demographics
NPI:1073276804
Name:BERNARD, SOPHIA YANIKAH (PMHNP)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:YANIKAH
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 VAN BUSKIRK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6210
Mailing Address - Country:US
Mailing Address - Phone:551-285-8524
Mailing Address - Fax:
Practice Address - Street 1:42 VAN BUSKIRK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-6210
Practice Address - Country:US
Practice Address - Phone:551-285-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01167200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health