Provider Demographics
NPI:1710794011
Name:SOSSOUS, MORIAH ELIZABETH
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:ELIZABETH
Last Name:SOSSOUS
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 1:2351 E MALL DR APT 310
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9136
Mailing Address - Country:US
Mailing Address - Phone:863-212-0977
Mailing Address - Fax:
Practice Address - Street 1:2351 E MALL DR APT 310
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9136
Practice Address - Country:US
Practice Address - Phone:863-212-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter