Provider Demographics
NPI:1366115610
Name:WALDMAN, SOPHIE (PA-C)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SHORE DR S
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-5323
Mailing Address - Country:US
Mailing Address - Phone:516-658-9053
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW STE M4200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2196
Practice Address - Country:US
Practice Address - Phone:202-444-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical