Provider Demographics
NPI:1245800580
Name:SOZONOV, VYACHESLAV
Entity Type:Individual
Prefix:
First Name:VYACHESLAV
Middle Name:
Last Name:SOZONOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7789 ARUNDEL MILLS BLVD APT 415
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2023
Mailing Address - Country:US
Mailing Address - Phone:470-314-9263
Mailing Address - Fax:
Practice Address - Street 1:7789 ARUNDEL MILLS BLVD APT 415
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2023
Practice Address - Country:US
Practice Address - Phone:470-314-9263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1051544163W00000X
GARN258560163W00000X
MDR245024163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse