MEDICARE: DR. SONIA K DHALIWAL PSYD

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	103TC0700X	Clinical Psychologist	PY0890	NV

General Provider Information

NPI Number	:	1275285991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONIA K DHALIWAL PSYD

Provider Business Mailing Address
First Line	:	9065 ENTRANCING AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3072
Country	:	US
Telephone Number	:	503-803-2146
Fax Number	:

Provider Business Practice Location Address
First Line	:	9065 ENTRANCING AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3072
Country	:	US
Telephone Number	:	503-803-2146
Fax Number	:

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

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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