Provider Demographics
NPI:1881406619
Name:RILEY, SOPHIA CYNTHIA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:CYNTHIA
Last Name:RILEY
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 1:364 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55341-1301
Mailing Address - Country:US
Mailing Address - Phone:763-258-4916
Mailing Address - Fax:
Practice Address - Street 1:364 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MN
Practice Address - Zip Code:55341-1301
Practice Address - Country:US
Practice Address - Phone:763-258-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant