Healthcare Provider Details

I. General information

NPI: 1922979939
Provider Name (Legal Business Name): MADISYN MAXINE SONATY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 10/24/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 HAAN DR
WEST LAFAYETTE IN
47906-9652
US

IV. Provider business mailing address

1030 HAAN DR
WEST LAFAYETTE IN
47906-9652
US

V. Phone/Fax

Practice location:
  • Phone: 219-863-2871
  • Fax:
Mailing address:
  • Phone: 219-863-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28272488A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: