Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 049279 | NY |
NPI | 1033223565 |
---|---|
Provider Name | Dr. Sophia L Scantlebury |
First Address | Brooklyn, NY 11238-4954 |
Second Address | Brooklyn, NY 11238-4954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31355933 | (05) | NY |