Provider Demographics
NPI:1326388463
Name:REYES, SOFIA MARIE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:SOFIA MARIE
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BROADHOLLOW ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:631-693-6644
Mailing Address - Fax:631-693-4389
Practice Address - Street 1:100 BROADHOLLOW ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735
Practice Address - Country:US
Practice Address - Phone:631-693-6644
Practice Address - Fax:631-693-4389
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health