MEDICARE: SONYA N DUROSINMI ETTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker	308527	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982291357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONYA N DUROSINMI ETTI

Provider Business Mailing Address
First Line	:	2641 WALLCREST BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4886
Country	:	US
Telephone Number	:	614-273-5978
Fax Number	:

Provider Business Practice Location Address
First Line	:	2641 WALLCREST BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4886
Country	:	US
Telephone Number	:	614-273-5978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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Directions to “ SONYA N DUROSINMI ETTI ” Practice Location

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