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General NPI Number Information
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NPI Number | 1952422693
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Entity Type | Individual
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Provider Name | SONY GARY SANON PA
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 18802 SW 55 ST
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City | MIRAMAR
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State | FL
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Zip | 33029-6291
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Country | US
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Telephone | 305-978-5069
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Fax | 954-442-2545
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Provider Business Mailing Address
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Address Line | 152 NE 167TH ST UNIT 102
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-3400
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Country | US
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Telephone | 305-978-5069
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Fax | 954-442-2545
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA003363
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License Number State | FL
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