Provider Demographics
NPI:1255762217
Name:SOEUNG, SOPHANY
Entity type:Individual
Prefix:
First Name:SOPHANY
Middle Name:
Last Name:SOEUNG
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 1:2492 STATE ROUTE 79
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-9719
Mailing Address - Country:US
Mailing Address - Phone:607-220-6408
Mailing Address - Fax:
Practice Address - Street 1:2492 STATE ROUTE 79
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886-9719
Practice Address - Country:US
Practice Address - Phone:607-220-6408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305733164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse