Provider Demographics
NPI:1720664329
Name:ST. LOUIS-AUGUSTIN, SORAYA MICHELLE
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:MICHELLE
Last Name:ST. LOUIS-AUGUSTIN
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 1:22 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1002
Mailing Address - Country:US
Mailing Address - Phone:862-219-3218
Mailing Address - Fax:
Practice Address - Street 1:22 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1002
Practice Address - Country:US
Practice Address - Phone:862-219-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26363LP2300X
NJ26NR11741400363LP2300X
NJ26NJ01137700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care