Provider Demographics
NPI:1174130058
Name:SORESSO, SANDRA JUDITH
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JUDITH
Last Name:SORESSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16500 HEATHER LN APT 101
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8320
Mailing Address - Country:US
Mailing Address - Phone:440-390-9252
Mailing Address - Fax:
Practice Address - Street 1:16500 HEATHER LN APT 101
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8320
Practice Address - Country:US
Practice Address - Phone:440-390-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care