Provider Demographics
NPI:1174287148
Name:SIATKOWSKI, SONDRA AKINS (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:AKINS
Last Name:SIATKOWSKI
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7469 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-3557
Mailing Address - Country:US
Mailing Address - Phone:440-339-3204
Mailing Address - Fax:
Practice Address - Street 1:9485 MENTOR AVE STE 210
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8723
Practice Address - Country:US
Practice Address - Phone:440-255-5571
Practice Address - Fax:440-255-5548
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029339363LA2200X
OH0029339363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health