Provider Demographics
NPI:1912224833
Name:VEINOGLOU, SOPHIA M (FNP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:M
Last Name:VEINOGLOU
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 1:780 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-2180
Mailing Address - Country:US
Mailing Address - Phone:413-528-2418
Mailing Address - Fax:413-644-8822
Practice Address - Street 1:780 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2149
Practice Address - Country:US
Practice Address - Phone:413-528-2418
Practice Address - Fax:413-644-8822
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN202113363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner