Provider Demographics
NPI:1174235360
Name:BROWNSTEIN, SOPHIA GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:GRACE
Last Name:BROWNSTEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1150 RESERVOIR AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6032
Mailing Address - Country:US
Mailing Address - Phone:401-223-2828
Mailing Address - Fax:401-223-2825
Practice Address - Street 1:1150 RESERVOIR AVE STE 300
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6032
Practice Address - Country:US
Practice Address - Phone:401-223-2828
Practice Address - Fax:401-223-2825
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPA01675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant