Provider Demographics
NPI:1760508956
Name:HARRIS, SONYA A (MS CCC-SLP, BCS-CL)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS CCC-SLP, BCS-CL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 FORMAX DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9327
Mailing Address - Country:US
Mailing Address - Phone:407-204-9163
Mailing Address - Fax:
Practice Address - Street 1:650 N ALAFAYA TRAIL
Practice Address - Street 2:SUITE 101 #782028
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828
Practice Address - Country:US
Practice Address - Phone:407-204-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889405100Medicaid