Provider Demographics
NPI:1083812622
Name:QATSHA, SONIA LOUSIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:LOUSIA
Last Name:QATSHA
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 1:29728 ENGLISH WAY
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2033
Mailing Address - Country:US
Mailing Address - Phone:248-884-5617
Mailing Address - Fax:248-788-8227
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:SUITE #250
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3230
Practice Address - Country:US
Practice Address - Phone:248-985-5000
Practice Address - Fax:248-985-5500
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
MI5601005013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered