Provider Demographics
NPI:1326890492
Name:ELIASSI, SOPHIA HANNAH (PA)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:HANNAH
Last Name:ELIASSI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STEAMBOAT RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1833
Mailing Address - Country:US
Mailing Address - Phone:516-996-9798
Mailing Address - Fax:
Practice Address - Street 1:225 EASTVIEW DR
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4539
Practice Address - Country:US
Practice Address - Phone:516-996-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant