Provider Demographics
NPI:1922503671
Name:CYRIAC, SOPHIA (NP)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:CYRIAC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SOPHIAMOL
Other - Middle Name:
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8264 268TH ST
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1562
Mailing Address - Country:US
Mailing Address - Phone:718-570-5284
Mailing Address - Fax:
Practice Address - Street 1:8264 268TH ST
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1562
Practice Address - Country:US
Practice Address - Phone:718-570-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308362-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health