Provider Demographics
NPI:1982277224
Name:SORGE, FELISHA ANN
Entity Type:Individual
Prefix:
First Name:FELISHA
Middle Name:ANN
Last Name:SORGE
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 1:2130 HAZEN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1047
Mailing Address - Country:US
Mailing Address - Phone:347-670-7421
Mailing Address - Fax:
Practice Address - Street 1:2130 HAZEN ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1047
Practice Address - Country:US
Practice Address - Phone:347-670-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency