Provider Demographics
NPI:1679323067
Name:VENERO SHIMABUKURO, SOPHIA (MD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:VENERO SHIMABUKURO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DR. SOPHIA
Other - Middle Name:
Other - Last Name:VENERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:147 BEACH ROAD, SUITE A
Mailing Address - Street 2:WESTHAMPTON BEACH CONTINUITY CLINIC:WESTHAMPTON PRIMARY
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11949
Mailing Address - Country:US
Mailing Address - Phone:631-288-7746
Mailing Address - Fax:
Practice Address - Street 1:WESTHAMPTON BEACH CONTINUITY CLINIC:WESTHAMPTON PRIMARY
Practice Address - Street 2:147 BEACH ROAD, SUITE A
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11949
Practice Address - Country:US
Practice Address - Phone:631-288-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program