Provider Demographics
NPI:1629488168
Name:WORTH, SOPHIA (FNP, BC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:WORTH
Suffix:
Gender:F
Credentials:FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4702
Mailing Address - Country:US
Mailing Address - Phone:914-941-1263
Mailing Address - Fax:
Practice Address - Street 1:29 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4811
Practice Address - Country:US
Practice Address - Phone:914-923-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY574861163W00000X
NY338644-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04035489Medicaid