Provider Demographics
NPI:1518020437
Name:ROBERTS, SONYA MARIE (AS)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:AS
Other - Prefix:MISS
Other - First Name:SONYA
Other - Middle Name:MARIE
Other - Last Name:DONEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AS
Mailing Address - Street 1:6 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-1408
Mailing Address - Country:US
Mailing Address - Phone:585-314-2189
Mailing Address - Fax:
Practice Address - Street 1:11 MURRAY HILL DR
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1153
Practice Address - Country:US
Practice Address - Phone:585-243-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005478-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant