Provider Demographics
NPI:1083114847
Name:SOPRANO, ALYSSA MARIE (DNP)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MARIE
Last Name:SOPRANO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 REDCOAT DR.
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:704-301-7562
Mailing Address - Fax:
Practice Address - Street 1:108 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-8037
Practice Address - Country:US
Practice Address - Phone:803-286-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21578163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1366464497Medicaid
SC1053325076Medicaid