# SOVEREIGN PHOENIX

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871909093
- **Authorized official:** TYRONE BARNETT (OWNER)
- **Authorized official phone:** (516) 303-0967

## Contact information

- **Practice address:** 15 CUTTERMILL RD, GREAT NECK, NY 11021-3252
- **Practice address phone:** (516) 303-0967
- **Mailing address:** 15 CUTTERMILL RD, GREAT NECK, NY 11021-3252

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171W00000X | Contractor | — | NULL | Yes |
| 171W00000X | Contractor | — | — | Yes |

## Other

- **Enumeration date:** 07/08/2014
- **Last updated:** 07/08/2014