Healthcare Provider Details

I. General information

NPI: 1528828902
Provider Name (Legal Business Name): STELLA SONU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BROOKLINE PL
BROOKLINE MA
02445-7230
US

IV. Provider business mailing address

1818 SW 4TH AVE APT 1116
PORTLAND OR
97201-5568
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDENT.DE.70111227
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: