Provider Demographics
NPI:1457044505
Name:SIDIQI, SORIA
Entity Type:Individual
Prefix:
First Name:SORIA
Middle Name:
Last Name:SIDIQI
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 1:13 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5507
Mailing Address - Country:US
Mailing Address - Phone:845-545-0207
Mailing Address - Fax:
Practice Address - Street 1:200 MIDWAY PARK DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2642
Practice Address - Country:US
Practice Address - Phone:845-341-0666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist