Provider Demographics
NPI:1316190564
Name:JAGWANI, SONYA SUNDER (MD)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:SUNDER
Last Name:JAGWANI
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 1:17051 DALLAS PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-7107
Mailing Address - Country:US
Mailing Address - Phone:314-374-3614
Mailing Address - Fax:
Practice Address - Street 1:17051 DALLAS PKWY STE 350
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7107
Practice Address - Country:US
Practice Address - Phone:314-374-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-01
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009010234207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology