Provider Demographics
NPI:1629735378
Name:SMALL, SONDIA MARTINA NAOMI
Entity Type:Individual
Prefix:
First Name:SONDIA
Middle Name:MARTINA NAOMI
Last Name:SMALL
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 1:1122 SELDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23523-2126
Mailing Address - Country:US
Mailing Address - Phone:757-579-8807
Mailing Address - Fax:
Practice Address - Street 1:1122 SELDEN AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23523-2126
Practice Address - Country:US
Practice Address - Phone:757-579-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health