Provider Demographics
NPI:1578558771
Name:SOFINSKI, SANDRA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JEAN
Last Name:SOFINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATTN: SANDRA SOFINSKI, MD
Mailing Address - Street 2:2305 AARON ST, #411
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:310-948-8148
Mailing Address - Fax:
Practice Address - Street 1:SANDRA SOFINSKI, MD
Practice Address - Street 2:2305 AARON ST, #411
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:310-948-8148
Practice Address - Fax:310-948-8148
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME150114207WX0107X, 208D00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A93257Medicare UPIN