Provider Demographics
NPI:1972310654
Name:BLACK, SOPHIA ELLIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ELLIZABETH
Last Name:BLACK
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:7 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2520
Mailing Address - Country:US
Mailing Address - Phone:978-491-7137
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5372
Practice Address - Country:US
Practice Address - Phone:978-491-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant