MS. SOPHIA BOURDEAU (NPI# 1689104192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689104192 |
| Entity Type | Individual |
| Full Name | MS. SOPHIA BOURDEAU |
| Credential | LPN |
| Practice Address |
159 Sw South Danville Cir Port St Lucie FL 34953-5929 |
| Practice Telephone | (754) 234-3487 |
| Mailing Telephone | 7542343487 |
| Enumeration Date | 2017-06-16 |
| Last Update Date | 2017-06-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
FL | Ambulatory Health Care Facilities |
| Street Address |
159 SW SOUTH DANVILLE CIR |
| City | PORT ST LUCIE |
| State | FL |
| Zip Code | 34953-5929 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033733720 | Paul Desantis | Optometrist | 1805 Gatlin Blvd, Port St. Lucie, FL 34953 | 2020-05-29 |
| 1174165997 | D&r Homehealthcare LLC | Technician | 1210 Southwest Santiago Avenue, Port Saint Lucie, Fl, FL 34953 | 2019-10-14 |
| 1023677630 | Physical Therapy Wellness Group | Clinic/Center | 519 Sw Nagle Place, Port Saint Lucie, FL 34953 | 2019-06-07 |
| 1063993699 | Bloom Firm, LLC | Home Health | 1714 Sw Cycle St, Port Saint Lucie, FL 34953 | 2018-08-22 |
| 1386121333 | For His Glory Alf LLC. | Assisted Living Facility | 322 Sw South Quick Circle, Port St Lucie, FL 34953 | 2018-07-23 |
| 1730670555 | Susan May Thyme | Nurse Practitioner | 1762 Sw Choate St, Port Saint Lucie, FL 34953 | 2018-05-29 |
| 1164911301 | Viven Banks | Counselor | 3581 Sw Kromrey St, Port Saint Lucie, FL 34953 | 2018-05-03 |
| 1205323441 | Katherine Monroig | Behavior Technician | 4557 Se Babylon St, Port Saint Lucie, FL 34953 | 2018-04-13 |
| 1528567583 | Roger Rene Trudel | Nurse Practitioner | 3686 Sw Carmody Street, Port St Lucie, FL 34953 | 2018-02-06 |
| 1801315502 | Metushela Nicolas | Adult Companion | 1112 Jennifer Ter, Port Saint Lucie, FL 34953 | 2017-09-13 |
| Find all providers in zip 34953 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972084697 | Your Personalized Care Services, LLC | Clinic/Center | 8960 Carlton Rd, Port St Lucie, FL 34987-3225 | 2018-08-22 |
| 1649766676 | Reference Home Care Inc | Clinic/Center | 1845 Sw Via Rossa, Port St Lucie, FL 34953-4665 | 2018-07-02 |
| 1497259741 | Uniquely 4 Hearts, LLC | Clinic/Center | 1808 Se North Buttonwood Dr, Port St Lucie, FL 34952-6967 | 2018-03-21 |
| 1447753694 | Shakera Ann Morris | Clinic/Center | 905 Ne Prima Vista Blvd Ste A, Port St Lucie, FL 34952-2360 | 2018-03-14 |
| 1780197749 | Tiffany Losius | Clinic/Center | 2065 Se Lennard Rd Apt 105, Port St Lucie, FL 34952-4752 | 2017-11-13 |
| 1821501156 | Philippe Alexander | Clinic/Center | 6365 Nw Regal Cir, Port St Lucie, FL 34983-5358 | 2017-11-08 |
| 1669984167 | Brian Tatum | Clinic/Center | 6905 Heritage Dr, Port St Lucie, FL 34952-8227 | 2017-10-25 |
| 1174037592 | Marlene Y Samuels | Clinic/Center | 4241 Sw Hagaplan St, Port St Lucie, FL 34953-6583 | 2017-11-21 |
| 1558801324 | Valley Stream Gardens Inc | Clinic/Center | 482 Sw Todd Ave, Port St Lucie, FL 34983-2914 | 2017-02-27 |
| 1073068318 | Quality Home Health | Clinic/Center | 8944 Sandshot Ct Apt A, Port St Lucie, FL 34986-3607 | 2016-08-16 |
| Find all providers in PORT ST LUCIE | ||||
| City | PORT ST LUCIE |
| Zip Code | 34953 |
Please comment or provide details below to improve the information on MS. SOPHIA BOURDEAU.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.