Provider Demographics
NPI:1184339582
Name:MANFREDI, SOFIA
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:MANFREDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 BARCLAY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5940
Mailing Address - Country:US
Mailing Address - Phone:718-501-8197
Mailing Address - Fax:
Practice Address - Street 1:3767 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3505
Practice Address - Country:US
Practice Address - Phone:347-465-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist