Healthcare Provider Details

I. General information

NPI: 1174800999
Provider Name (Legal Business Name): SONJA DEAN HAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 W SAND LAKE RD SUITE 210
ORLANDO FL
32819-5200
US

IV. Provider business mailing address

1000 PALM COAST PKWY SW STE 109
PALM COAST FL
32137-4747
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-9679
  • Fax: 407-351-9689
Mailing address:
  • Phone: 386-447-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: