Provider Demographics
NPI:1790063402
Name:MAHBOOB, SONEA (MD)
Entity Type:Individual
Prefix:
First Name:SONEA
Middle Name:
Last Name:MAHBOOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PARSONS WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2539
Mailing Address - Country:US
Mailing Address - Phone:551-574-3004
Mailing Address - Fax:
Practice Address - Street 1:2500 CASSADY AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2674
Practice Address - Country:US
Practice Address - Phone:814-345-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2678822084P0800X
WI692062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry