MEDICARE: SONJA DEAN HAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	AS4503	FL

General Provider Information

NPI Number	:	1174800999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJA DEAN HAS

Provider Business Mailing Address
First Line	:	1000 PALM COAST PKWY SW STE 109
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4747
Country	:	US
Telephone Number	:	386-447-3530
Fax Number	:

Provider Business Practice Location Address
First Line	:	7208 W SAND LAKE RD
Second Line	:	SUITE 210
City	:	ORLANDO
State	:	FL
Zip	:	32819-5200
Country	:	US
Telephone Number	:	407-351-9679
Fax Number	:	407-351-9689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	11/08/2011

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