Provider Demographics
NPI:1477217065
Name:ALEXANDER, SOPHIE (CN)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5252
Mailing Address - Country:US
Mailing Address - Phone:607-280-7188
Mailing Address - Fax:
Practice Address - Street 1:520 W GREEN ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5252
Practice Address - Country:US
Practice Address - Phone:607-280-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist