Provider Demographics
NPI:1629760640
Name:SOROKACH, KASSANDRA RENEE (L AP, DIP OM)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:RENEE
Last Name:SOROKACH
Suffix:
Gender:F
Credentials:L AP, DIP OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9479 CR 735
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:FL
Mailing Address - Zip Code:33597-4043
Mailing Address - Country:US
Mailing Address - Phone:352-603-7763
Mailing Address - Fax:
Practice Address - Street 1:109 E JOE P STRICKLAND JR AVE
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-6116
Practice Address - Country:US
Practice Address - Phone:352-603-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist