Provider Demographics
NPI:1518541028
Name:DEARAUJO, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:DEARAUJO
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 1:22 CHERSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-2512
Mailing Address - Country:US
Mailing Address - Phone:774-263-5060
Mailing Address - Fax:
Practice Address - Street 1:300B FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1257
Practice Address - Country:US
Practice Address - Phone:508-374-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2304476Medicaid