Provider Demographics
NPI:1013917160
Name:SORRESSO, DOMENICK J (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMENICK
Middle Name:J
Last Name:SORRESSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 JACQUE RD STE C
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7195
Mailing Address - Country:US
Mailing Address - Phone:727-857-5967
Mailing Address - Fax:727-857-5972
Practice Address - Street 1:7614 JACQUE RD STE C
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7195
Practice Address - Country:US
Practice Address - Phone:727-857-5967
Practice Address - Fax:727-857-5972
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77399207RP1001X
FLMR77399207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
46527OtherBLUE CROSS BLUE SHIELD
FL257232000Medicaid
FLG91007Medicare UPIN
FL46527ZMedicare ID - Type Unspecified