Provider Demographics
NPI:1326631920
Name:WADE BANNERT, SONIA RENEE
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:RENEE
Last Name:WADE BANNERT
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 1:17966 N TAMIAMI TRL STE 145
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-1414
Mailing Address - Country:US
Mailing Address - Phone:239-997-0588
Mailing Address - Fax:941-999-4283
Practice Address - Street 1:1500 PLACIDA RD STE B3
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4951
Practice Address - Country:US
Practice Address - Phone:941-474-4637
Practice Address - Fax:941-999-4283
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5473237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist