Provider Demographics
NPI:1578294724
Name:GO, SONIA MAE (NP)
Entity Type:Individual
Prefix:
First Name:SONIA MAE
Middle Name:
Last Name:GO
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 1:9319 LAFAYETTE WALK
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6907
Mailing Address - Country:US
Mailing Address - Phone:718-395-0529
Mailing Address - Fax:
Practice Address - Street 1:9319 LAFAYETTE WALK
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6907
Practice Address - Country:US
Practice Address - Phone:718-395-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310488363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health