Individual
ALEAH SOPHIA INNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11 ROUTE 111, SMITHTOWN, NY 11787-3754
(631) 920-8303
Mailing address
11 ROUTE 111, SMITHTOWN, NY 11787-3754
(319) 920-8303
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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