Provider Demographics
NPI:1194860254
Name:SORRENTINO, PATRICIA MARIE (MSN,PNP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARIE
Last Name:SORRENTINO
Suffix:
Gender:F
Credentials:MSN,PNP
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:MARIE
Other - Last Name:HIGGINBOTHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 BRIMFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4619
Mailing Address - Country:US
Mailing Address - Phone:716-674-8097
Mailing Address - Fax:
Practice Address - Street 1:219 BRYANT ST
Practice Address - Street 2:1095 JEFFERSON AVENUE BUFFALO NY 14209
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-480-0499
Practice Address - Fax:716-878-1152
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381082-1372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00361968Medicaid
NY040260003328OtherFIDELIS PROVIDER #