Provider Demographics
NPI:1922675396
Name:GRACIA, SONIA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:SONIA
Middle Name:
Last Name:GRACIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-5925
Mailing Address - Country:US
Mailing Address - Phone:631-682-9154
Mailing Address - Fax:
Practice Address - Street 1:11 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-5925
Practice Address - Country:US
Practice Address - Phone:631-682-9154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant