Provider Demographics
NPI:1467488007
Name:SONDA, CHARLENE (NP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:SONDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 LUCERNE DR STE 405
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6503
Mailing Address - Country:US
Mailing Address - Phone:440-234-8833
Mailing Address - Fax:440-234-3313
Practice Address - Street 1:6325 YORK RD STE 305
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3030
Practice Address - Country:US
Practice Address - Phone:440-845-8000
Practice Address - Fax:440-845-8001
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0323170-21363L00000X
OHAPRNCNP04918363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH212061Medicare PIN