Healthcare Provider Details

I. General information

NPI: 1356128987
Provider Name (Legal Business Name): SONYA L BURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 JAVIT COURT YOUNGSTOWN
OHIO OH
44515
US

IV. Provider business mailing address

440 S RACCOON RD APT 2
AUSTINTOWN OH
44515-3600
US

V. Phone/Fax

Practice location:
  • Phone: 330-797-4050
  • Fax:
Mailing address:
  • Phone: 216-512-3154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: