Provider Demographics
NPI:1225016611
Name:VENTOUR, SONYA SHERON (MD)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:SHERON
Last Name:VENTOUR
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 1:958 IRIS LANE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-771-4971
Mailing Address - Fax:516-771-2758
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:STE 303
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-771-4971
Practice Address - Fax:516-771-2758
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184350207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01888182Medicaid
NY03783Medicare ID - Type UnspecifiedGHI
NY01888182Medicaid
G45129Medicare UPIN