Provider Demographics
NPI:1629097951
Name:STEVENS, SONYA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SONYA
Middle Name:M
Last Name:STEVENS
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 1:276 DUTTON RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2807
Mailing Address - Country:US
Mailing Address - Phone:978-440-8004
Mailing Address - Fax:
Practice Address - Street 1:616 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3376
Practice Address - Country:US
Practice Address - Phone:978-443-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157070208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3190544Medicaid
MA3190544Medicaid
MAG80299Medicare UPIN