Provider Demographics
NPI:1871359372
Name:BUFFA, SOPHAN (BA, BED)
Entity type:Individual
Prefix:
First Name:SOPHAN
Middle Name:
Last Name:BUFFA
Suffix:
Gender:F
Credentials:BA, BED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15001 KERCHEVAL AVE # 322
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1361
Mailing Address - Country:US
Mailing Address - Phone:313-444-5474
Mailing Address - Fax:
Practice Address - Street 1:929 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1821
Practice Address - Country:US
Practice Address - Phone:586-719-4051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion