Provider Demographics
NPI:1780421388
Name:CALIXTE, SOPHIA
Entity type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:
Last Name:CALIXTE
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 1:60 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6921
Mailing Address - Country:US
Mailing Address - Phone:516-469-1663
Mailing Address - Fax:
Practice Address - Street 1:60 CROWN ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-6921
Practice Address - Country:US
Practice Address - Phone:516-469-1663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9617952163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse