Provider Demographics
NPI:1811200421
Name:TSIMIS, SOPHIA C (MA CCC-TSSLD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:C
Last Name:TSIMIS
Suffix:
Gender:F
Credentials:MA CCC-TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14312 WILLETS POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3461
Mailing Address - Country:US
Mailing Address - Phone:646-621-7845
Mailing Address - Fax:
Practice Address - Street 1:8403 57TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4833
Practice Address - Country:US
Practice Address - Phone:718-899-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist