Provider Demographics
NPI:1053062455
Name:WILCOX, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 W SAN PEDRO ST FL 33629
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7923
Mailing Address - Country:US
Mailing Address - Phone:904-710-1547
Mailing Address - Fax:
Practice Address - Street 1:3406 W SAN PEDRO ST FL 33629
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7923
Practice Address - Country:US
Practice Address - Phone:904-710-1547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician