Provider Demographics
NPI:1114639408
Name:CHACKO, SONA ELIZABETH
Entity Type:Individual
Prefix:
First Name:SONA
Middle Name:ELIZABETH
Last Name:CHACKO
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 1:5117 SW 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-4222
Mailing Address - Country:US
Mailing Address - Phone:954-306-4338
Mailing Address - Fax:
Practice Address - Street 1:5117 SW 93RD AVE
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-4222
Practice Address - Country:US
Practice Address - Phone:954-309-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29038124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist