Provider Demographics
NPI:1689037491
Name:MATHISSON, SONIA (MS, RD, IBCLC)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:MATHISSON
Suffix:
Gender:F
Credentials:MS, RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ERIN CT
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 ERIN CT
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:NY
Practice Address - Zip Code:10546-1004
Practice Address - Country:US
Practice Address - Phone:914-450-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-85295174N00000X
NY815962133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered