Provider Demographics
NPI:1972494482
Name:JUAREZ, SONIA L (CNS, LDN)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:L
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11264 SUFFOLK DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-4066
Mailing Address - Country:US
Mailing Address - Phone:240-513-7607
Mailing Address - Fax:
Practice Address - Street 1:11264 SUFFOLK DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-4066
Practice Address - Country:US
Practice Address - Phone:240-513-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-12
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX7372133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDX7372OtherMD LICENSE
19128OtherCNS NO