Provider Demographics
NPI:1407915713
Name:RAISHEVICH, SONYA III
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:
Last Name:RAISHEVICH
Suffix:III
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 1:937 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2336
Mailing Address - Country:US
Mailing Address - Phone:718-336-0783
Mailing Address - Fax:718-336-7203
Practice Address - Street 1:937 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2336
Practice Address - Country:US
Practice Address - Phone:718-336-0783
Practice Address - Fax:718-336-7203
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYG727611744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management