Provider Demographics
NPI:1174800999
Name:DEAN, SONJA (HAS)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PALM COAST PKWY SW STE 109
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4747
Mailing Address - Country:US
Mailing Address - Phone:386-447-3530
Mailing Address - Fax:
Practice Address - Street 1:7208 W SAND LAKE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5200
Practice Address - Country:US
Practice Address - Phone:407-351-9679
Practice Address - Fax:407-351-9689
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4503237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL208617752OtherFEDERAL TAX ID NUMBER