Provider Demographics
NPI:1205006749
Name:CLARKE, SOPHIA LOREEN (NP)
Entity Type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:LOREEN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3027
Mailing Address - Country:US
Mailing Address - Phone:516-354-1499
Mailing Address - Fax:
Practice Address - Street 1:1999 MARCUS AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1017
Practice Address - Country:US
Practice Address - Phone:516-466-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303738363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health