Provider Demographics
NPI:1629007059
Name:DICKINSON, SOPHIE SZWAGIEL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIE
Middle Name:SZWAGIEL
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NELSON ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1944
Mailing Address - Country:US
Mailing Address - Phone:315-253-4463
Mailing Address - Fax:315-253-5624
Practice Address - Street 1:23 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-1149
Practice Address - Country:US
Practice Address - Phone:585-624-2121
Practice Address - Fax:585-624-7283
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330085363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNP0503OtherPREFERRED CARE
NYP019330085OtherBCBS
NYNP0503OtherPREFERRED CARE
NYS90649Medicare UPIN