Provider Demographics
NPI:1760776900
Name:SONNIS PEDIATRICS, INC.,
Entity Type:Organization
Organization Name:SONNIS PEDIATRICS, INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESWARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-382-0566
Mailing Address - Street 1:1125 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-3350
Mailing Address - Country:US
Mailing Address - Phone:863-767-1616
Mailing Address - Fax:863-767-1619
Practice Address - Street 1:1125 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3350
Practice Address - Country:US
Practice Address - Phone:863-767-1616
Practice Address - Fax:863-767-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004416500Medicaid
FL006449300Medicaid
103952Medicare Oscar/Certification
FL001ZBMedicare PIN