Provider Demographics
NPI:1609066240
Name:ELLIOTT, SONNI P (MD)
Entity Type:Individual
Prefix:
First Name:SONNI
Middle Name:P
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11532
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-4232
Mailing Address - Country:US
Mailing Address - Phone:913-333-0448
Mailing Address - Fax:913-444-2913
Practice Address - Street 1:12620 JUNIPER CIR
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-3129
Practice Address - Country:US
Practice Address - Phone:314-324-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100159322084P0800X
KS04-357522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200655980BMedicaid
KSG93000012Medicare PIN