Provider Demographics
NPI:1760879985
Name:SOPASOUDAKIS, IRENE (MSED)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:SOPASOUDAKIS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 89TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5611
Mailing Address - Country:US
Mailing Address - Phone:917-498-4661
Mailing Address - Fax:
Practice Address - Street 1:229 89TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5611
Practice Address - Country:US
Practice Address - Phone:917-498-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-26
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist