Provider Demographics
NPI:1609059286
Name:MARSHALL, SONYA LISA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SONYA
Middle Name:LISA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 POHEGANUT DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3252
Mailing Address - Country:US
Mailing Address - Phone:860-437-3737
Mailing Address - Fax:860-437-0530
Practice Address - Street 1:85 POHEGANUT DR
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3252
Practice Address - Country:US
Practice Address - Phone:860-437-3737
Practice Address - Fax:860-437-0530
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT871213E00000X
CTCT871213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty