Sophia Bourdeau, LPN

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Practice address

159 SW South Danville Cir
Port St Lucie, FL 34953-5929

Phone

(754) 234-3487

NPI assigned

Jun 16, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1689104192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 SW SOUTH DANVILLE CIR",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349535929",
            "telephone_number": "754-234-3487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 SW SOUTH DANVILLE CIR",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349535929",
            "telephone_number": "754-234-3487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURDEAU",
        "first_name": "SOPHIA",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmental Disabilities Clinic/Center in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.