Provider Demographics
NPI:1437180031
Name:SERRANO, SOPHIA ANDREOLA (PA)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ANDREOLA
Last Name:SERRANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:MICHELLE
Other - Last Name:ANDREOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 11593
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4006
Mailing Address - Country:US
Mailing Address - Phone:972-747-0440
Mailing Address - Fax:972-747-0441
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE 310 MOB1
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-747-0440
Practice Address - Fax:972-747-0441
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04443363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant