Provider Demographics
NPI:1275935967
Name:POWELL, SOFIA (FNP)
Entity Type:Individual
Prefix:MS
First Name:SOFIA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:
Other - Last Name:PAPPAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27U MADISON PARK GDNS
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3209
Mailing Address - Country:US
Mailing Address - Phone:516-883-3640
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-562-4895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338599-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily