Provider Demographics
NPI:1568242691
Name:GARY, SOPHIA D (EDD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:D
Last Name:GARY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 GWYNN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1106
Mailing Address - Country:US
Mailing Address - Phone:631-456-3672
Mailing Address - Fax:
Practice Address - Street 1:512 GWYNN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1106
Practice Address - Country:US
Practice Address - Phone:631-392-0081
Practice Address - Fax:631-392-0081
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist