Provider Demographics
NPI:1942876750
Name:CAPUA, SOFIA EDDA (PA-C)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:EDDA
Last Name:CAPUA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1142
Mailing Address - Country:US
Mailing Address - Phone:413-733-9600
Mailing Address - Fax:413-747-1860
Practice Address - Street 1:3455 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1142
Practice Address - Country:US
Practice Address - Phone:413-733-9600
Practice Address - Fax:413-747-1860
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA8127363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical