MEDICARE: SONIA CAROLINA DEATON PA

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	363A00000X	Physician Assistant	PA16613	TX

General Provider Information

NPI Number	:	1255062329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA CAROLINA DEATON PA

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	561-570-5172
Fax Number	:	786-472-5770

Provider Business Practice Location Address
First Line	:	917 S PORT AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-2301
Country	:	US
Telephone Number	:	361-887-0584
Fax Number	:	361-887-0586

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

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	03/26/2026

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Directions to “ SONIA CAROLINA DEATON PA” Practice Location

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