Provider Demographics
NPI:1114217270
Name:SONDERMAN, NICHOLE LEE (MD)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:LEE
Last Name:SONDERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 STATE ST
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1419
Mailing Address - Country:US
Mailing Address - Phone:866-492-7597
Mailing Address - Fax:
Practice Address - Street 1:900 STATE ST
Practice Address - Street 2:SUITE 203B
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1419
Practice Address - Country:US
Practice Address - Phone:866-492-7597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY468662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100211350Medicaid