Provider Demographics
NPI:1730678582
Name:WANDJI, SONYA L (NP)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:L
Last Name:WANDJI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 COUNTY ROAD 529
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2457
Mailing Address - Country:US
Mailing Address - Phone:256-631-6830
Mailing Address - Fax:
Practice Address - Street 1:929 W PIONEER PKWY STE A
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4726
Practice Address - Country:US
Practice Address - Phone:214-612-6164
Practice Address - Fax:817-796-1100
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily