Provider Demographics
NPI:1811721319
Name:PRUSS, SOFIYA ALEXIS (PA-C)
Entity type:Individual
Prefix:
First Name:SOFIYA
Middle Name:ALEXIS
Last Name:PRUSS
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:11708 RUSSET MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4231
Mailing Address - Country:US
Mailing Address - Phone:314-440-8251
Mailing Address - Fax:
Practice Address - Street 1:10923 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7740
Practice Address - Country:US
Practice Address - Phone:314-764-2953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant