Provider Demographics
NPI:1588722003
Name:SOBOL, SVETLANA (FNP)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:SOBOL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5141
Mailing Address - Country:US
Mailing Address - Phone:718-987-2862
Mailing Address - Fax:718-434-9939
Practice Address - Street 1:330 HUNTER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5141
Practice Address - Country:US
Practice Address - Phone:718-987-2862
Practice Address - Fax:718-434-9939
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily