Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP022803 | PA |
NPI | 1396347860 |
---|---|
Provider Name | Dr. Melissa Adalila Soberanis Sanabria |
First Address | Newark, DE 19713-2911 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2020 |
Last Update Date | 10/11/2020 |