Provider Demographics
NPI:1861714644
Name:SOKOLI, DESIREE (APN)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:SOKOLI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 N BROAD ST RM 1A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-4106
Mailing Address - Country:US
Mailing Address - Phone:215-926-9019
Mailing Address - Fax:
Practice Address - Street 1:1316 W ONTARIO ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5220
Practice Address - Country:US
Practice Address - Phone:215-707-2400
Practice Address - Fax:215-707-4034
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00279600364SF0001X
PASP028692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00279600Medicaid
NJ26NJ00279600Medicaid
NJ26NJ00279600Medicare PIN