Healthcare Provider Details

I. General information

NPI: 1386124626
Provider Name (Legal Business Name): SONJA J NEEDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N AURORA ST
ITHACA NY
14850-3725
US

IV. Provider business mailing address

138 CECIL MALONE DR
ITHACA NY
14850-5124
US

V. Phone/Fax

Practice location:
  • Phone: 607-319-4423
  • Fax:
Mailing address:
  • Phone: 607-273-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number516471-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: