Provider Demographics
NPI:1881034817
Name:POLANCO, SORALDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:SORALDA
Middle Name:
Last Name:POLANCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 WEST 27TH STREET
Mailing Address - Street 2:A402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5992
Mailing Address - Country:US
Mailing Address - Phone:212-217-4190
Mailing Address - Fax:
Practice Address - Street 1:227 W 27TH ST
Practice Address - Street 2:F.I.T. HEALTH SERVICE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5902
Practice Address - Country:US
Practice Address - Phone:212-217-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33 338186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily