Provider Demographics
NPI:1659366599
Name:POWELL, SORAYA M (CRNA)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:M
Last Name:POWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5520
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-0520
Mailing Address - Country:US
Mailing Address - Phone:610-954-5810
Mailing Address - Fax:610-954-5480
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:610-954-5810
Practice Address - Fax:610-954-5480
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN312903L163W00000X
PA071613367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1622824OtherHIGHMARK
PA50037030OtherCAPITAL ADVANTAGE
PA11803103OtherCAQH
PA1545483OtherGATEWAY
PA1622824OtherFIRST PRIORITY
PA2000725OtherKHP CENTRAL
PA87368OtherGEISINGER
PA2299723000OtherIND. BLUE CROSS
PA1025567200002Medicaid
PA9855448OtherAETNA
PA87368OtherGEISINGER
PA9855448OtherAETNA
PA1622824OtherHIGHMARK