Healthcare Provider Details

I. General information

NPI: 1760776900
Provider Name (Legal Business Name): SONNI'S PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 S 6TH AVE
WAUCHULA FL
33873-3350
US

IV. Provider business mailing address

1125 S 6TH AVE
WAUCHULA FL
33873-3350
US

V. Phone/Fax

Practice location:
  • Phone: 863-767-1616
  • Fax: 863-767-1619
Mailing address:
  • Phone: 863-767-1616
  • Fax: 863-767-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURENCE THOMAS HREN
Title or Position: CEO
Credential:
Phone: 863-676-1770