Provider Demographics
NPI:1174393458
Name:SONNICK, CHANEL (BS)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:SONNICK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 OSWEGO ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-1045
Mailing Address - Country:US
Mailing Address - Phone:315-886-7437
Mailing Address - Fax:
Practice Address - Street 1:18 OSWEGO ST APT 2
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-1045
Practice Address - Country:US
Practice Address - Phone:315-886-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program